Abstract
Objective (1) To propose a novel technique named thoracic extensive laminoplasty (TELP) in curing severe thoracic ligamentum flavum ossification (STOLF) and (2) to compare outcomes between TELP and laminectomy in curing STOLF. Methods Cases with fused or tuberous STOLF (Sato classification) treated from Jan 2015 to Jan 2017 were reviewed and divided into the TELP group (G1) and laminectomy group (G2) according to their surgical management. Data on demographics, complications, pre- and postoperative symptoms, residual spinal canal area (RSCA-1), residual spinal cord area (RSCA-2), modified Japanese Orthopedic Association score (mJOA), and health-related quality of life (HRQOL, based on the SF-36) were collected. Results Fifty-nine G1 and sixty-two G2 patients were enrolled. No significant differences in demographic data or preoperative data of RSCA-1, RSCA-2, mJOA, or HRQOL were observed between the two groups (p > 0.05). Patients in G1 and G2 showed similar postoperative improvements in RSCA-1 and RSCA-2 at the final follow-up (p > 0.05). However, patients in G1 showed higher postoperative improvements in mJOA (OR = 2.706, 95% CI: 1.279~5.727, p = 0.008) at the final follow-up. Patients in G1 also showed higher postoperative improvements in HRQOL than patients in G2 (p < 0.05) at the final follow-up, and patients with more severe STOLF presented with better improvements in HRQOL in G1 (p < 0.05). Dural laceration and cerebrospinal fluid leakage were observed in seven G2 patients, and no complications were found in G1 patients after surgery. Conclusion TELP is a novel, effective, and safer surgical technique in treating STOLF and could be a substitute for traditional laminectomy.
Highlights
Thoracic ossification of the ligamentum flavum (TOLF) is the most common cause of thoracic spinal stenosis, and it eventually leads to thoracic myelopathy, which was first reported by Tamaguchi et al in 1960 [1]
These results indicated that thoracic extensive laminoplasty (TELP) might be more suitable for severe thoracic ligamentum flavum ossification (STOLF) than laminectomy, which could be explained by the less invasive procedure of TELP that decreased the risk of neurologic damage
Our study proposed a novel and effective TELP technique for STOLF
Summary
Thoracic ossification of the ligamentum flavum (TOLF) is the most common cause of thoracic spinal stenosis, and it eventually leads to thoracic myelopathy, which was first reported by Tamaguchi et al in 1960 [1]. TOLF occurs mainly in East Asia, including Korea, Japan, and China. Previous studies indicated that the incidence of TOLF was 21.8% (1090/4999) [2], 12% (180/1500) [3], and 3.8% (66/1736) [4] in Korea, Japan, and China, respectively. In China, it was reported that 63.9% of patients with chest symptoms were diagnosed with TOLF [5]. Most patients have already had a loss of functional gait when they come to see a doctor, and their prognosis is always poor [6, 7]. How to effectively treat TOLF (especially severe TOLF (STOLF)) is still a challenge for doctors
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