Comparison of Surgical Results of the Bridge Crane Technique Versus Laminectomy for the Treatment of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Abstract

Study Design: A retrospective study. Objectives: This study aimed to evaluate the safety and effectiveness of the bridge crane technique versus laminectomy for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum (OLF). Methods: Totally 41 patients who underwent surgical decompression due to thoracic OLF from May 2017 to June 2018 in our institution were enrolled in this study and were divided into group BG (bridge crane technique, n = 19) and group L (laminoectomy, n = 22). Demographic data was collected from medical records and the modified Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological outcomes during the follow-up. Surgery-related complications were analyzed. Results: The mean duration of follow-up was comparable between group BG (19.4 ± 1.5 months) and group L (19.6 ± 1.4 months). No statistical differences were observed between two groups in terms of gender, age, duration of symptoms, preoperative occupying rate, involved levels, operation time, intraoperative blood loss, and complications. The JOA score significantly increased at the final follow-up in both groups. However, patients in group BG had higher JOA score and recovery rate ( P < 0.05). Four patients in group L experienced complications, including 3 cerebrospinal fluid (CSF) leakage and one postoperative hematoma. Only one patient in group BG had CSF leakage. Conclusion: The results of this study suggested that bridge crane technique may be relatively safe and effective for patients with symptomatic thoracic OLF with more satisfactory clinical improvement. However, high-quality studies are still required to validate the results of this study.

Ossified Ligamentum Flavum: Epidemiology, Treatment, and Outcomes

“…The sutures are tied down, thereby bringing the bone-OLF complex dorsally and allowing the dura to expand. 27…”

“…Additionally, the rates of CSF leakage were 5.3% in the bridge crane compared with 13.6% in the laminectomy group. 27…”

“…The sutures are tied down, thereby bringing the bone-OLF complex dorsally and allowing the dura to expand. 27 In cases where either wide decompression by facetectomy is necessary, thereby potentially destabilizing the affected spinal segment, or if ventral pathology is concomitantly addressed instrumented fusion should be done in addition to decompression.…”

“…Additionally, the rates of CSF leakage were 5.3% in the bridge crane compared with 13.6% in the laminectomy group. 27 Another study examining kyphosis correction with resection of OLF demonstrated that decompression and fusion aided in focal kyphosis correction from 30°preoperatively to 21°postoperatively. In addition, JOA scores increased from 3.5 preoperatively to 8.5 postoperatively, demonstrating that decompression with instrumented fusion can adequately correct thoracic sagittal deformity and provide improvements in overall function.…”

Lamina-Lifting Suspension Modification in Bridge Crane Technique in Treatment of Severe Thoracic Ossification of the Ligamentum Flavum (TOLF)

“…Hence, the development of safe and efficient decompression methods remains a persistent technical challenge. Sun [ 10 , 11 ] first proposed the “bridge crane technique” in 2018, which enables direct decompression while preserving the integrity of the posterior column. Based on the aforementioned concepts, we have developed a lamina-lifting suspension system that optimizes utilization of the bridge crane technique in TOLF.…”