Preliminary report of modified expansive laminoplasty in the treatment of thoracic ossification of the ligamentum flavum

Abstract

Objective This study was performed to evaluate the role of posterior suspension of the laminae–ossification of the ligamentum flavum complex combined with miniplate fixation (modified expansive thoracic laminoplasty) in treating thoracic ossification of the ligamentum flavum (TOLF). Methods Eight patients with TOLF treated by modified expansive thoracic laminoplasty were retrospectively analyzed. Their general information, operative time, intraoperative blood loss, and postoperative complications were recorded. Neurological functional recovery was evaluated by the modified Japanese Orthopaedic Association (mJOA) score and Hirabayashi recovery rate preoperatively, postoperatively, and at the final follow-up. Preoperative and postoperative imaging was performed, and the decompression range and internal fixation positioning were evaluated. Results The mJOA score significantly improved from 4.63 points preoperatively to 9.0 points at the final follow-up (Hirabayashi recovery rate of 77.75%). Postoperative computed tomography and magnetic resonance imaging revealed sufficient decompression of the surgical segment. At the final follow-up, the internal implants were well-placed, the lamina–ligamentum flavum complex showed no significant displacement, and neurological functional recovery was satisfactory. Conclusion Surgical treatment of TOLF is complicated and high-risk. Characterized by simplicity and sufficient decompression, modified expansive thoracic laminoplasty can reduce the risk of cerebrospinal fluid leakage and nerve injury with satisfactory neurological functional recovery.

Preoperative Magnetic Resonance Imaging Signal Intensity Classification Is Associated With Clinical Presentation and Surgical Outcomes in Myelopathy Caused by Thoracic Ossification of Ligamentum Flavum: A Multicenter Study

“… 39 Thoracic extended laminoplasty was also a new indirect decompression approach, which achieved better mJOA and HRQOL scores than laminectomy without complications. 40 , 41 Although indirect decompression approaches avoided the risk of dual sac and nerve root injury, the inability to observe directly the border of lesion complicated the evaluation of the decompression effect. It is still necessary to pay more attention to the management of patients with Grade 2 ISI.…”

Ossified Ligamentum Flavum: Epidemiology, Treatment, and Outcomes

“…One study of 8 patients demonstrated an average mJOA recovery from 4.63 preoperatively to 9.0 postoperatively and no immediate postoperative complications. 38 A second study examined laminoplasty compared with laminectomy for OLF and found that while patients in both cohorts shared similar preoperative characteristics, patients in the laminoplasty cohort experienced markedly greater improvements in mJOA score compared with laminectomy, as well as greater improvements in health-related quality of life and space available for the spinal cord. Dural tears occurred in 11.2% of the patients undergoing laminectomy and no patients undergoing laminoplasty.…”