Percutaneous Endoscopic Spine Minimally Invasive Technique for Decompression Therapy of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Miao, Xinxin; He, Dingwen; Wu, Tianlong

doi:10.1016/j.wneu.2018.02.152

Cited by 41 publications

(32 citation statements)

References 17 publications

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“…To the best of our knowledge, all the published studies on prognostic factors in OLF patients have been based on traditional open surgery. However, MIS has been advantageous in treating OLF with satisfactory surgical results 12,[15][16][17] . This study investigated the prognostic factors following MIS and was based on the retrospective analysis of OLF patients who underwent percutaneous full endoscopic posterior decompression (PEPD).…”

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confidence: 99%

Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum

Gao

et al. 2020

Sci Rep

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Minimally invasive surgery (MIS) has shown satisfactory surgical results for the treatment of thoracic myelopathy (TM) caused by ossification of the ligamentum flavum (OLF). This study investigated the prognostic factors following MIS and was based on the retrospective analysis of OLF patients who underwent percutaneous full endoscopic posterior decompression (PEPD). Thirty single-segment OLF patients with an average age of 60.4 years were treated with PEPD under local anaesthesia. Clinical data were collected from the medical and operative records. The surgical results were assessed by the recovery rate (RR) calculated from the modified Japanese Orthopaedic Association (mJOA) score. Correlations between the RR and various factors were analysed. Patients' neurological status improved from a preoperative mJOA score of 6.0 ± 1.3 to a postoperative mJOA score of 8.5 ± 2.0 (P < 0.001) at an average follow-up of 21.3 months. The average RR was 53.8%. Dural tears in two patients (6.7%, 2/30) were the only observed complications. Multiple linear regression analysis showed that a longer duration of preoperative symptoms and the presence of a high intramedullary signal on T2-weighted MRI (T2HIS) were significantly associated with poor surgical results. PEPD is feasible for the treatment of TM patients with a particular type of OLF. Patients without T2HIS could achieve a good recovery if they received PEPD early. Thoracic myelopathy (TM) is less common than cervical myelopathy and lumbar spinal stenosis 1 , and TM is mainly caused by ossification of the ligamentum flavum (OLF) in East Asian countries, such as Japan, Korea, and China 2. As the number of reported cases has increased, OLF has been studied not only in East Asia but also worldwide 3-5. Although much of its pathophysiology has been determined, the exact pathogenetic mechanism and the epidemiology of OLF remain poorly understood 6,7. Therefore, making an appropriate and timely therapeutic decision for the treatment of OLF may be hindered by the paucity of knowledge. TM caused by OLF remains a challenge for spine surgeons. OLF generally requires posterior surgical decompression due to its progressive nature and poor response to conservative therapy 8,9. Decompression procedures include traditional open surgeries, such as laminectomy with or without posterior fusion 10,11 , and minimally invasive surgery (MIS), such as microendoscopic decompression 12,13 and percutaneous endoscopic decompression 14-17. However, the prognostic guidelines are still unclear, and the surgical results vary widely despite complete decompression 3,18 .

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confidence: 99%

Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum

Gao

et al. 2020

Sci Rep

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“…There are still few relative discussions about the use of percutaneous spine endoscopic technique in the field of thoracic spine especially for patients with Thoracic Ossification of Ligamentum Flavum. Only one literature has reported percutaneous endoscopic spine technique in the treatment of Thoracic Myelopathy Caused by OLF [12]. However, it only provided two cases which may influence the results.…”

Section: Complicationsmentioning

confidence: 99%

“…It is believed that posterior decompression can achieve satisfactory surgical results in patients with T-OLF [7]. At present, the main operation methods are laminoplasty, partial laminectomy, enbloc laminectomy, lamina fenestration technique and percutaneous endoscopic spine minimally invasive technique [8][9][10][11][12]. Nevertheless, there are few literature compares the effectiveness and safety between percutaneous endoscopic laminectomy and traditional laminectomy in T-OLF with CT classification of type unilateral segments.…”

Section: Introductionmentioning

confidence: 99%

A comparison of clinical outcomes between percutaneous endoscopic laminectomy decompression and traditional laminectomy decompression in Thoracic Ossification of Ligamentum Flavum with CT classification of type unilateral segments.

Wu¹,

Huang²,

He³

et al. 2020

Preprint

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Background: The aim of this study was to compare the effectiveness and safety of percutaneous endoscopic laminectomy decompression and traditional laminectomy decompression in the treatment of Thoracic Ossification of Ligamentum Flavum (T-OLF) with CT classification of type unilateral segments. Methods: We executed a retrospective study on 24 cases of T-OLF with CT classification of type unilateral segments between May 2015 and January 2018. All the patients were divided into two groups based on the relation to surgical methods. Patients in group A underwent percutaneous endoscopic laminectomy, and in group B underwent traditional laminectomy. According to the selection criteria, there were 10 patients in group A and 14 patients in group B. We mainly analyzed and compared the clinical, radiologic, perioperative outcomes, and surgery-related complications of the two groups of data. Results: Both groups improved significantly in the following projects：the JOA scores, mean JOA recovery rate, leg pain and radiologic results of decompression. However, no significant difference was found between the two groups. One case occurred dural tear in the early phase of percutaneous endoscopic laminectomy group. One patient occurred dural tear in during removal of OLF adhered to the dura mater in traditional laminectomy group. There were no cases of failure or recurrence in both groups. The percutaneous endoscopic laminectomy group have significant advantages in the following areas: back pain recovery, blood loss, hospital stay, hospitalization expenses and return-to-work. No post-laminectomy kyphosis was observed in any patients. Conclusions: Although percutaneous endoscopic laminectomy in thoracic region has a steep learning curve, percutaneous endoscopic laminectomy seemed to be an alternative surgical for T-OLF, type unilateral segments.

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“…Based on improvements in optical technology and equipment, good outcomes and advantages of PED for lumbar degenerative disease have been used in recent years [ 6 , 7 ] . However, there were few reports of PED for the treatment of TSS [ 8 , 9 ]. The objective of this study was to compare the outcome of PED versus PDL for TSS.…”

Section: Introductionmentioning

confidence: 99%

A comparison study of percutaneous endoscopic decompression and posterior decompressive laminectomy in the treatment of thoracic spinal stenosis

Cheng

Bian

Liu

et al. 2020

BMC Musculoskelet Disord

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Background Percutaneous endoscopic decompression (PED) is considered a minimally invasive and safe procedure in lumbar degenerative disease. Few authors report the success of PED for thoracic spinal stenosis (TSS) with thoracic myelopathy. The objective of this study was to compare the outcome of PED versus posterior decompressive laminectomy (PDL) for TSS. Methods We retrospectively reviewed 30 consecutive patients who underwent surgery for single-level TSS from January 1, 2015 to May 1, 2019.These patients were divided into PED (n = 16) and PDL(n = 14) group. Preoperative demographic characteristics and perioperative outcomes were reviewed. Pre- and postoperative neurological status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score and the recovery rate (RR). Results The patients’ mean age was 57.3 years (27–76) in PED group and 58.8 years (34–77) in PDL group. No statistical difference was found between two groups with regards to neurological status at pre-operative and final follow-up. The RR in PED group achieved the same improvement as PDL group (87.5% vs 85.7%, P > 0.05), while the PED brought advantages in operative time(m) (86.4 vs 132.1, p < 0.05), blood loss (mL) (18.21 vs 228.57, p < 0.05),drainage volume(mL) (15.5 vs 601.4, p < 0.05), and hospital stay (d) (3.6 vs 5.6, p < 0.05). Conclusions Both PED and PDL showed favorable outcome in the treatment of TSS. Besides, PED had advantages in reducing traumatization. In terms of perioperative quality of life, PED could be an efficient supplement to traditional posterior decompressive laminectomy in patients with TSS.

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Percutaneous Endoscopic Spine Minimally Invasive Technique for Decompression Therapy of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Cited by 41 publications

References 17 publications

Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum

Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum

A comparison of clinical outcomes between percutaneous endoscopic laminectomy decompression and traditional laminectomy decompression in Thoracic Ossification of Ligamentum Flavum with CT classification of type unilateral segments.

A comparison study of percutaneous endoscopic decompression and posterior decompressive laminectomy in the treatment of thoracic spinal stenosis

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