Lamina Osteotomy and Replantation With Miniplate Fixation for Thoracic Myelopathy Due to Ossification of the Ligamentum Flavum

Abstract

Lamina osteotomy and replantation with miniplate fixation is often used to treat benign intradural tumors, effectively preventing nerve entrapment and postoperative spinal deformities. However, no studies report using this technique to treat thoracic myelopathy due to ossification of the ligamentum flavum (OLF). This article reports the clinical outcome of a series of 18 cases of contiguous multilevel OLF treated by lamina osteotomy and replantation with miniplate fixation.Eighteen consecutive patients at the authors' institution were treated between 2008 and 2010 for contiguous multilevel OLF. Clinical efficacy, operative time, blood loss, sagittal alignment, and complications were investigated. Japanese Orthopaedic Association scale scores improved from 4.7±1.4 preoperatively to 7.9±1.3 three months postoperatively and 8.8±1.3 at final follow-up (P<.01), with a mean recovery rate of 67.8%±13.1%. No significant kyphotic deformity occurred postoperatively, and local kyphosis in the treated area increased by a mean of only 1.9°±1.0° at final follow-up. No patient required additional surgery due to spinal canal reobstruction and progressive spinal deformity. Cerebrospinal fluid leakage occurred in 4 patients and resolved after repair. Pulmonary infection and deep venous thrombosis occurred in 1 patient who was discharged with no complications after routine treatment.Lamina osteotomy and replantation with miniplate fixation is an effective therapeutic option for thoracic myelopathy due to contiguous multilevel OLF compression. The technique provides adequate decompression and stabilized sagittal alignment and avoids invasion of the spinal canal by scar tissue.

<p>Subsection Laminectomy with Pedicle Screw Fixation to Treat Thoracic Ossification of Ligamentum Flavum: A Comparative Analysis with Lamina Osteotomy and the Replantation Technique</p>

“…14 After improvement, LORF has been applied to the treatment of TOLF. 10,15 First, bilateral grooves are made in the second safe area, then the head and tail laminae and adjacent structures are dissected and removed. After the ossified ligament tissue was removed, in situ replantation was performed.…”

“…However, after several years of clinical observation, spinal surgeons found that LORF presented a higher surgical risk and incidence of complications. 5,10 According to Chen et al, 5 during the overall lifting process of long-segment laminae, three patients had a dural sac laceration with an incidence rate of 18.8% (3/16 patients). Moreover, one patient presented with lower limb paralysis after surgery.…”

“…The bone defect at the outer edge of the lamina was covered with allogenic bone strips ( Figure 2). 10…”

“…12 The neurological recovery rate was calculated as follows: postoperative JOA score − preoperative JOA score)/ (11 − preoperative JOA score) × 100%. The American Spinal Injury Association (ASIA) neurological grading 10 was used to determine the recovery of neurological function. Grade For personal use only.…”

“…[5][6][7][8][9] Posterior spinal canal resection and decompression are among the most frequently used surgical techniques, including laminae delamination, 5 lamina fenestration technique, 6 open-door or French-door laminectomy, 7 en-bloc resection, 8,9 and lamina osteotomy and replantation. 10 Each technique has specific characteristics. As a classical operation, the delamination method of decompression is easy to perform, but the surgical forceps must invade the vertebral canal continuously during lamina removal.…”