Computed Tomography Radiographic Measurements and Curative Effect Estimate of Full Endoscopic Surgery in Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Abstract

Purpose: In this study, computed tomography (CT) radiographic measurements and common clinical scores were used to evaluate the effectiveness of percutaneous posterior full-endoscopic resection of an ossified thoracic ligamentum flavum. Methods: A prospective study was conducted on 16 patients treated with posterior endoscopy from September 2017 to November 2019. Before the operation, 3 days after the operation and 1 year after the operation, the area of ossification in the ligamentum flavum was assessed by sagittal CT scans and transected to evaluate the decompression effect of posterior endoscopic surgery. The clinical efficacy of the surgery was evaluated at the above time points by using the visual analog scale for pain, modified Japanese Orthopedic Association scale, ODI and Macnab efficacy evaluation. Results: The area of sagittal ossification in the ligamentum flavum in 16 patients was 116.62±32.72 mm2 before the operation, 15.99±12.54 mm2 3 days after the operation, and 16.78±11.49 mm2 1 year later. The sagittal canal invasive proportions were 48.10±10.04% before the operation, 6.46±4.86% 3 days after the operation, and 6.83±4.48% 1 year later. The area of transected ossification in the ligamentum flavum was 141.59±27.25 mm2 before the operation, 11.72±8.64 mm2 3 days after the operation, and 10.82±7.57 1 year later. The transected spinal canal invasive proportions were 57.58±11.37%, 4.76±3.45% and 4.40±3.01%. The mJOA score were 3.50±1.10, 6.19±0.91 and 9.19±1.38, with a n average recovery rate of 73.96±16.58%. According to the Macnab evaluation, the recovery status of the 16 patients 1 year after the operation was excellent in 9 patients, good in 5 patients, and fair in 2 patients; the excellent and good rate was 87.50%. The differences were statistically significant (P<0.05). Intraoperative dural tears occurred in 2 of 16 patients, but no complications, such as cerebrospinal fluid leakage, were observed. Conclusion：The measurements of ossification ligamentum flavum area and spinal canal invasive proportion can appropriately evaluate the degree of spinal canal stenosis in thoracic myelopathy caused by ossification of the ligamentum flavum. This method can be used together with other common clinical scores to better evaluate the efficacy of surgery.

Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification

“…In total, 23 relevant studies were included in this analysis, 10–32 enrolling 323 patients (177 males, 146 females) with a mean age of 58.40±10.06 years (Fig. 2).…”