A systematic review of surgical procedures on thoracic myelopathy

Abstract

Purpose The surgical treatment of thoracic myelopathy is still controversial and also a challenge for spine surgeons. Therefore, the objective of this study was to review the related literature on the surgical treatment of thoracic myelopathy and try to define treatment guidelines for spine surgeons on thoracic myelopathy. Methods Relevant literatures were searched based on the PubMed, EMBASE, and Cochrane Library between January 2008 and December 2018. Some data on the characteristics of patients were extracted, including number of patients, mean age, surgical procedures, blood loss, complications, and pre-/post-operation modified JOA score. Recovery rate was used to assess the effect of surgery outcome, and the safety was evaluated by blood loss and incidence of complications. Results Thirty-five studies met the inclusion criteria and were retrieved. A total of 2183 patients were included in our systematic review, with the average age of 55.2 years. There were 69.8% patients diagnosed as ossification of ligamentum flavum (OLF), 20.0% as ossification of posterior longitudinal ligament (OPLL), 9.3% as disk herniation (DH), and 0.9% as others including diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS). The volume of blood loss was more in the treatment of circumferential decompression (CD) than posterior decompression (PD), and the incidence of complications was higher in CD (P < 0.05). The volume of blood loss in minimally invasive surgery (MIS) was lowest and the incidence of complications was 19.2%. Post-operation recovery rate was 0.49 in PD, 0.35 in CD, and 0.29 in MIS while the recovery rate was 0.54 in PD, 0.55 in CD, and 0.49 in MIS at the last follow-up. When focusing on the OLF specifically, incidence of complications in PD was much lower than CD, with less blood loss and higher recovery rate. Focusing on the OPLL specifically, incidence of complications in PD was much lower than CD, with less blood loss while there was no statistical difference in recovery rate between these two methods. Conclusions This systematic review showed that posterior decompression for thoracic myelopathy is safer and better than circumferential decompression according to the complication rate and surgical outcome. And we should also consider the location of compression before the operation.

CT-based radiographic measurements and effectiveness estimates of full-endoscopic surgery in thoracic myelopathy caused by ossification of ligamentum flavum

“…According to the Macnab efficacy evaluation, the excellent and good rate was 87.5%. Compared with traditional open surgery (34.6–76.7%) [ 8 ], this method may have obvious advantages. The above results serve as strong evidence of the clinical treatment effect of posterior full endoscopic surgery on TM secondary to OLF.…”

“…By removing the ossified ligamentum flavum and/or expanding the spinal canal to decompress the spinal cord, the nerve could be saved. Although the clinical effect of traditional treatments for thoracic ligamentum flavum ossification were clear, it still has many disadvantages, such as substantial trauma and a high rate of complications (34%~76.7%) [ 8 – 13 ], which often lead to additional pain and financial burden in patients and their families. In recent years, the endoscopic technique has been used for the treatment of ossification of the thoracic ligamentum flavum [ 14 – 17 ].…”

Degenerative Thoracic Myelopathy: A Scoping Review of Epidemiology, Genetics, and Pathogenesis

“…Post-surgical outcomes in DTM depend on many factors, such as the operative approach, causative pathology, symptom duration, and presence of additional stenosis. 30,104 For OLF, statistically significant improvements of JOA scores are reported, although recovery is typically incomplete. 57,59,112,113 Recovery is dependent on several factors, such as preoperative neurological status, duration of symptoms, imaging findings, age, sex, number of levels involved, and type of OLF.…”

“…In Japanese populations, in which most of the included studies were conducted, OLF and OPLL are the commonest causes, followed by disc herniation, with rare causes including calcification of the ligamentum flavum and degenerative spondylolisthesis. 11,[27][28][29][30][31] A recent systematic review found that in Japan, 45% of cases were OPLL, 36.4% OLF, 16.5% OPLL with OLF and 2.1% disc herniation, 31 whilst in China, 75.8% of cases were OLF, 13.8% disc herniation, 6.6% OPLL and 3.8% OPLL with OLF. 31 That same study found that in the US, disc herniation is the commonest aetiology with 95.7% of cases, with OLF making up 3.6% and OPLL .5%.…”

Risk factors for perioperative hidden blood loss after one-segment posterior circumferential decompression surgery on thoracic ossification of the posterior longitudinal ligament: a finding of the double-layer sign on CT

“…Such a surgical procedure can directly remove the pressure substance in front of the spinal cord to achieve direct decompression. However, research has indicated that the incidence of complications in posterior circumferential decompression is much higher than that in single posterior decompression with more blood loss, although there are no signi cant differences in neurological recovery [15].…”