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Circumferential Spinal Cord Decompression through a Single Posterior Approach with Microendoscopy for Thoracic and Thoracolumbar Ossification of the Posterior Longitudinal Ligament.

Seki S, Mine H, Kawaguchi Y, Makino H, Kimura T - Asian Spine J (2015)

Bottom Line: Preoperative symptoms were substantially improved in both patients.To date, we have used this novel technique to treat five patients with thoracic or thoracolumbar OPLL.This new surgical technique is likely to be useful in patients with a beak-type OPLL of the thoracic or thoracolumbar spine.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.

ABSTRACT
Thoracic and thoracolumbar ossification of the posterior longitudinal ligament (OPLL) can be difficult to treat due to the anatomical position. The purpose of this study was to report the significance of a novel surgical technique that represented two cases of thoracic or thoracolumbar OPLL. The first patient was a 72-year-old woman who had a beak-type OPLL at the T11/12. The second was a 45-year-old woman who had a beak-type OPLL at the T12/L1. We performed circumferential spinal cord decompression through a single posterior approach with microendoscopy in both cases. The postoperative computed tomography revealed the complete removal of the OPLL, and the magnetic resonance imaging confirmed adequate decompression of the spinal cord. Preoperative symptoms were substantially improved in both patients. To date, we have used this novel technique to treat five patients with thoracic or thoracolumbar OPLL. This new surgical technique is likely to be useful in patients with a beak-type OPLL of the thoracic or thoracolumbar spine.

No MeSH data available.


Related in: MedlinePlus

Circumferential spinal cord decompression with microendoscopic surgery. (A) A posterior view of the spine. Laminectomy and facetectomy were achieved after pedicle screw insertion. (B) An axial views of the spine. The intervertebral disc was removed bilaterally from around the dura mater. (C) An axial views of the spine. Ossification of the posterior longitudinal ligament (OPLL) positioned on the lateral aspects of the dura was removed with an air drill under direct observation. If adhesion between the dura mater and OPLL was recognized, the dura was carefully detached from the OPLL with a micro spurtle under microendoscopy. (D, E) An axial views of the spine. Microendoscopic resection of OPLL occurring ventrally to the spinal cord is performed bilaterally to the dura mater. (F) An axial views of the spine. Remaining OPLL around the central and ventral dura mater is removed with the air drill under observation by microendoscopy from the opposite side. (G) An axial views of the spine. Circumferential spinal cord decompression is confirmed by microendoscopy from both sides.
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Figure 3: Circumferential spinal cord decompression with microendoscopic surgery. (A) A posterior view of the spine. Laminectomy and facetectomy were achieved after pedicle screw insertion. (B) An axial views of the spine. The intervertebral disc was removed bilaterally from around the dura mater. (C) An axial views of the spine. Ossification of the posterior longitudinal ligament (OPLL) positioned on the lateral aspects of the dura was removed with an air drill under direct observation. If adhesion between the dura mater and OPLL was recognized, the dura was carefully detached from the OPLL with a micro spurtle under microendoscopy. (D, E) An axial views of the spine. Microendoscopic resection of OPLL occurring ventrally to the spinal cord is performed bilaterally to the dura mater. (F) An axial views of the spine. Remaining OPLL around the central and ventral dura mater is removed with the air drill under observation by microendoscopy from the opposite side. (G) An axial views of the spine. Circumferential spinal cord decompression is confirmed by microendoscopy from both sides.

Mentions: The operative technique was planned to combine posterior decompression and fusion through a single posterior approach with microendoscopic resection of the anterior OPLL (Fig. 3). After a posterior midline incision was performed and the paravertebral muscles were exposed, pedicle screws were inserted into the upper and lower vertebrae of the affected intervertebral disc, using the free hand technique, followed by laminectomy and bilateral facetectomy to release the dura mater and nerve roots (Fig. 3A). After the bilateral roots were preserved with a micro spurtle, bleeding from the epidural venous plexus was stopped with a bipolar electrical scalpel. The intervertebral disc was removed bilaterally, and the OPLL that was positioned anteriorly to the dura mater was recognized (Fig. 3B). The ossified lesion on either side of the dura mater was resected under direct vision (Fig. 3C). Since adhesion of the dura mater and OPLL was noted, the dura mater was carefully detached from the OPLL with a knife or spurtle under the microendoscope that was inserted through the intervertebral disc space (Fig. 4A-C). The ossified lesion that was ventral to the dura mater was bilaterally excised with an air drill under the microendoscope, during which the dura mater was protected with particular care (Figs. 3D, E, 4D, E). We also took particular care to make sure that the displacement of the dura on retraction was less than one-third of the width of the dura mater. The microendoscope was then inserted from the opposite side of the intervertebral disc space, and the ossified mass that remained in the median area was excised under visual observation (Figs. 3E, 4F-H). This bilateral OPLL could be removed without retraction of the dura mater because the 25-degree oblique lens of the microendoscope provided good visibility of the ventral side of the dura mater. Upon completion of the decompression, the microendoscope was inserted from both sides of the intervertebral disc space to confirm complete circumferential decompression of the spinal cord (Figs. 3F, G, 4I-L). Bleeding from the vertebral bodies was controlled by filling defects with hemostatic gelatin sponge or application of a hemostatic bone wax under microendoscopy. Fig. 5 shows an intraoperative image and postoperative X-ray after circumferential spinal cord decompression and posterior fixation.


Circumferential Spinal Cord Decompression through a Single Posterior Approach with Microendoscopy for Thoracic and Thoracolumbar Ossification of the Posterior Longitudinal Ligament.

Seki S, Mine H, Kawaguchi Y, Makino H, Kimura T - Asian Spine J (2015)

Circumferential spinal cord decompression with microendoscopic surgery. (A) A posterior view of the spine. Laminectomy and facetectomy were achieved after pedicle screw insertion. (B) An axial views of the spine. The intervertebral disc was removed bilaterally from around the dura mater. (C) An axial views of the spine. Ossification of the posterior longitudinal ligament (OPLL) positioned on the lateral aspects of the dura was removed with an air drill under direct observation. If adhesion between the dura mater and OPLL was recognized, the dura was carefully detached from the OPLL with a micro spurtle under microendoscopy. (D, E) An axial views of the spine. Microendoscopic resection of OPLL occurring ventrally to the spinal cord is performed bilaterally to the dura mater. (F) An axial views of the spine. Remaining OPLL around the central and ventral dura mater is removed with the air drill under observation by microendoscopy from the opposite side. (G) An axial views of the spine. Circumferential spinal cord decompression is confirmed by microendoscopy from both sides.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522453&req=5

Figure 3: Circumferential spinal cord decompression with microendoscopic surgery. (A) A posterior view of the spine. Laminectomy and facetectomy were achieved after pedicle screw insertion. (B) An axial views of the spine. The intervertebral disc was removed bilaterally from around the dura mater. (C) An axial views of the spine. Ossification of the posterior longitudinal ligament (OPLL) positioned on the lateral aspects of the dura was removed with an air drill under direct observation. If adhesion between the dura mater and OPLL was recognized, the dura was carefully detached from the OPLL with a micro spurtle under microendoscopy. (D, E) An axial views of the spine. Microendoscopic resection of OPLL occurring ventrally to the spinal cord is performed bilaterally to the dura mater. (F) An axial views of the spine. Remaining OPLL around the central and ventral dura mater is removed with the air drill under observation by microendoscopy from the opposite side. (G) An axial views of the spine. Circumferential spinal cord decompression is confirmed by microendoscopy from both sides.
Mentions: The operative technique was planned to combine posterior decompression and fusion through a single posterior approach with microendoscopic resection of the anterior OPLL (Fig. 3). After a posterior midline incision was performed and the paravertebral muscles were exposed, pedicle screws were inserted into the upper and lower vertebrae of the affected intervertebral disc, using the free hand technique, followed by laminectomy and bilateral facetectomy to release the dura mater and nerve roots (Fig. 3A). After the bilateral roots were preserved with a micro spurtle, bleeding from the epidural venous plexus was stopped with a bipolar electrical scalpel. The intervertebral disc was removed bilaterally, and the OPLL that was positioned anteriorly to the dura mater was recognized (Fig. 3B). The ossified lesion on either side of the dura mater was resected under direct vision (Fig. 3C). Since adhesion of the dura mater and OPLL was noted, the dura mater was carefully detached from the OPLL with a knife or spurtle under the microendoscope that was inserted through the intervertebral disc space (Fig. 4A-C). The ossified lesion that was ventral to the dura mater was bilaterally excised with an air drill under the microendoscope, during which the dura mater was protected with particular care (Figs. 3D, E, 4D, E). We also took particular care to make sure that the displacement of the dura on retraction was less than one-third of the width of the dura mater. The microendoscope was then inserted from the opposite side of the intervertebral disc space, and the ossified mass that remained in the median area was excised under visual observation (Figs. 3E, 4F-H). This bilateral OPLL could be removed without retraction of the dura mater because the 25-degree oblique lens of the microendoscope provided good visibility of the ventral side of the dura mater. Upon completion of the decompression, the microendoscope was inserted from both sides of the intervertebral disc space to confirm complete circumferential decompression of the spinal cord (Figs. 3F, G, 4I-L). Bleeding from the vertebral bodies was controlled by filling defects with hemostatic gelatin sponge or application of a hemostatic bone wax under microendoscopy. Fig. 5 shows an intraoperative image and postoperative X-ray after circumferential spinal cord decompression and posterior fixation.

Bottom Line: Preoperative symptoms were substantially improved in both patients.To date, we have used this novel technique to treat five patients with thoracic or thoracolumbar OPLL.This new surgical technique is likely to be useful in patients with a beak-type OPLL of the thoracic or thoracolumbar spine.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.

ABSTRACT
Thoracic and thoracolumbar ossification of the posterior longitudinal ligament (OPLL) can be difficult to treat due to the anatomical position. The purpose of this study was to report the significance of a novel surgical technique that represented two cases of thoracic or thoracolumbar OPLL. The first patient was a 72-year-old woman who had a beak-type OPLL at the T11/12. The second was a 45-year-old woman who had a beak-type OPLL at the T12/L1. We performed circumferential spinal cord decompression through a single posterior approach with microendoscopy in both cases. The postoperative computed tomography revealed the complete removal of the OPLL, and the magnetic resonance imaging confirmed adequate decompression of the spinal cord. Preoperative symptoms were substantially improved in both patients. To date, we have used this novel technique to treat five patients with thoracic or thoracolumbar OPLL. This new surgical technique is likely to be useful in patients with a beak-type OPLL of the thoracic or thoracolumbar spine.

No MeSH data available.


Related in: MedlinePlus