nach oben

International Orthopaedics

Erschienen in:

11.01.2021 | Original Paper

Surgical strategy for non-continuous thoracic spinal stenosis: one- or two-stage surgery?

verfasst von: Longjie Wang, Hui Wang, Zhongqiang Chen, Chuiguo Sun, Weishi Li

Erschienen in: International Orthopaedics | Ausgabe 7/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Non-continuous thoracic spinal stenosis (NTSS) is a rare disease, but it is a challenging clinical entity for spine surgeons. However, few studies have focused on its treatment. Therefore, the purpose of this study was to provide surgical treatment guidelines for it by comparing the clinical outcomes of different surgical approaches.

Methods

Patients who underwent thoracic decompression surgery for two diseased segments with two incisions (normal segments ≥ 3) between January 2010 and December 2018 were included. Among these patients, nine were treated with posterior decompression (PD) and circumferential decompression (CD) procedures in one-stage surgery (group A), 14 with PD and CD procedures in two-stage surgery (group B), 36 patients with PD procedures in one-stage surgery and 15 with PD procedures in two-stage surgery (group D). Medical records, operative time, blood loss and complications were reviewed. Neurologic status was assessed by the modified Japanese Orthopaedic Association scale for thoracic myelopathy.

Results

Groups A, B, C and D were followed for 54.11 ± 20.51 months, 49.36 ± 29.30 months, 49.94 ± 31.94 months and 39.93 ± 26.18 months, respectively. When comparing groups A and B, operative time, blood loss and length of stay in hospital were significantly less in group A. However, the average recovery rate in group B was significantly higher than that in group A. In regard to groups C and D, group C showed a significantly shorter length of stay in hospital and lower rate of post-operative neurological deterioration. At final follow-up, groups C and D showed similar average recovery rates.

Conclusion

Different surgical procedures are suitable for different types of NTSS. For patients with NTSS mainly caused by posterior compression, PD via laminectomy in one-stage with two incisions can achieve satisfying clinical outcomes. Staged surgery, including CD and PD procedures, is recommended for patients with NTSS mainly caused by anterior compression.

Hou X, Sun C, Liu X, Liu Z, Qi Q, Guo Z, Li W, Zeng Y, Chen Z (2016) Clinical features of thoracic spinal stenosis-associated myelopathy: a retrospective analysis of 427 cases. Clin Spine Surg 29(2):86–89. https://doi.org/10.1097/BSD.0000000000000081CrossRefPubMed

Chen G, Fan T, Yang X, Sun C, Fan D, Chen Z (2020) The prevalence and clinical characteristics of thoracic spinal stenosis: a systematic review. Eur Spine J 29(9):2164–2172. https://doi.org/10.1007/s00586-020-06520-6CrossRefPubMed

Gao R, Yuan W, Yang L, Shi G, Jia L (2013) Clinical features and surgical outcomes of patients with thoracic myelopathy caused by multilevel ossification of the ligamentum flavum. Spine J 13(9):1032–1038. https://doi.org/10.1016/j.spinee.2013.02.034CrossRefPubMed

Yamazaki M, Okawa A, Fujiyoshi T, Furuya T, Koda M (2010) Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament. Eur Spine J 19(5):691–698. https://doi.org/10.1007/s00586-009-1266-4CrossRefPubMedPubMedCentral

Matsumoto M, Toyama Y, Chikuda H, Takeshita K, Kato T, Shindo S, Abumi K, Takahata M, Nohara Y, Taneichi H, Tomita K, Kawahara N, Imagama S, Matsuyama Y, Yamazaki M, Okawa A (2011) Outcomes of fusion surgery for ossification of the posterior longitudinal ligament of the thoracic spine: a multicenter retrospective survey: clinical article. J Neurosurg Spine 15(4):380–385. https://doi.org/10.3171/2011.6.SPINE10816CrossRefPubMed

Takahata M, Ito M, Abumi K, Kotani Y, Sudo H, Minami A (2008) Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine (Phila Pa 1976) 33(11):1199–1208. https://doi.org/10.1097/BRS.0b013e3181714515CrossRef

Ando K, Imagama S, Kaito T, Takenaka S, Sakai K, Egawa S, Shindo S, Watanabe K, Fujita N, Matsumoto M, Nakashima H, Wada K, Kimura A, Takeshita K, Kato S, Murakami H, Takeuchi K, Takahata M, Koda M, Yamazaki M, Watanabe M, Fujibayashi S, Furuya T, Kawaguchi Y, Matsuyama Y, Yoshii T, Okawa A (2020) Outcomes of surgery for thoracic myelopathy owing to thoracic ossification of the ligamentum flavum in a nationwide multicenter prospectively collected study in 223 patients: is instrumented fusion necessary? Spine (Phila Pa 1976) 45(3):E170–E178. https://doi.org/10.1097/BRS.0000000000003208CrossRef

Head J, Rymarczuk G, Stricsek G, Velagapudi L, Maulucci C, Hoelscher C, Harrop J (2019) Ossification of the posterior longitudinal ligament: surgical approaches and associated complications. Neurospine 16(3):517–529. https://doi.org/10.14245/ns.1938222.111CrossRefPubMedPubMedCentral

Fujimori T, Watabe T, Iwamoto Y, Hamada S, Iwasaki M, Oda T (2016) Prevalence, concomitance, and distribution of ossification of the spinal ligaments: results of whole spine CT scans in 1500 Japanese patients. Spine (Phila Pa 1976) 41(21):1668–1676. https://doi.org/10.1097/BRS.0000000000001643CrossRef

10.

Guo JJ, Luk KD, Karppinen J, Yang H, Cheung KM (2010) Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine (Phila Pa 1976) 35(1):51–56. https://doi.org/10.1097/BRS.0b013e3181b3f779CrossRef

11.

Feng FB, Sun CG, Chen ZQ (2015) Progress on clinical characteristics and identification of location of thoracic ossification of the ligamentum flavum. Orthop Surg 7(2):87–96. https://doi.org/10.1111/os.12165CrossRefPubMedPubMedCentral

12.

Overley SC, Kim JS, Gogel BA, Merrill RK, Hecht AC (2017) Tandem spinal stenosis: a systematic review. JBJS Rev 5(9):e2. https://doi.org/10.2106/JBJS.RVW.17.00007CrossRefPubMed

13.

Hu P, Yu M, Liu X, Liu Z, Jiang L (2015) A circumferential decompression-based surgical strategy for multilevel ossification of thoracic posterior longitudinal ligament. Spine J 15(12):2484–2492. https://doi.org/10.1016/j.spinee.2015.08.060CrossRefPubMed

14.

Chen CF, Chang MC, Liu CL, Chen TH (2004) Acute noncontiguous multiple-level thoracic disc herniations with myelopathy: a case report. Spine (Phila Pa 1976) 29(8):E157–E160. https://doi.org/10.1097/00007632-200404150-00024CrossRef

15.

Hou X, Chen Z, Sun C, Zhang G, Wu S, Liu Z (2018) A systematic review of complications in thoracic spine surgery for ossification of ligamentum flavum. Spinal Cord 56(4):301–307. https://doi.org/10.1038/s41393-017-0040-4CrossRefPubMed

16.

Xu N, Yu M, Liu X, Sun C, Chen Z, Liu Z (2017) A systematic review of complications in thoracic spine surgery for ossification of the posterior longitudinal ligament. Eur Spine J 26(7):1803–1809. https://doi.org/10.1007/s00586-015-4097-5CrossRefPubMed

17.

Liang H, Liu G, Lu S, Chen S, Jiang D, Shi H, Fei Q (2019) Epidemiology of ossification of the spinal ligaments and associated factors in the Chinese population: a cross-sectional study of 2000 consecutive individuals. BMC Musculoskelet Disord 20(1):253. https://doi.org/10.1186/s12891-019-2569-1CrossRefPubMedPubMedCentral

18.

Chen Y, Chen DY, Wang XW, Lu XH, Yang HS, Miao JH (2012) Single-stage combined decompression for patients with tandem ossification in the cervical and thoracic spine. Arch Orthop Trauma Surg 132(9):1219–1226. https://doi.org/10.1007/s00402-012-1540-5CrossRefPubMed

19.

Hu PP, Yu M, Liu XG, Liu ZJ, Jiang L (2017) Surgeries for patients with tandem spinal stenosis in cervical and thoracic spine: combined or staged surgeries? World Neurosurg 107:115–123. https://doi.org/10.1016/j.wneu.2017.07.129CrossRefPubMed

20.

Li WJ, Guo SG, Sun ZJ, Zhao Y (2015) Multilevel thoracic ossification of ligamentum flavum coexisted with/without lumbar spinal stenosis: staged surgical strategy and clinical outcomes. BMC Musculoskelet Disord 16:206. https://doi.org/10.1186/s12891-015-0672-5CrossRefPubMedPubMedCentral

21.

Hu P, Yu M, Liu X, Liu Z, Jiang L, Wei F, Chen Z (2016) Cerebrospinal fluid leakage after surgeries on the thoracic spine: a review of 362 cases. Asian Spine J 10(3):472–479. https://doi.org/10.4184/asj.2016.10.3.472CrossRefPubMedPubMedCentral

22.

Osman NS, Cheung ZB, Hussain AK, Phan K, Arvind V, Vig KS, Vargas L, Kim JS, Cho SK (2018) Outcomes and complications following laminectomy alone for thoracic myelopathy due to ossified ligamentum flavum: a systematic review and meta-analysis. Spine (Phila Pa 1976) 43(14):E842–E848. https://doi.org/10.1097/BRS.0000000000002563CrossRef

23.

Onishi E, Yasuda T, Yamamoto H, Iwaki K, Ota S (2016) Outcomes of surgical treatment for thoracic myelopathy: a single-institutional study of 73 patients. Spine (Phila Pa 1976) 41(22):E1356–E1363. https://doi.org/10.1097/BRS.0000000000001622CrossRef

24.

Marcus ML, Heistad DD, Ehrhardt JC, Abboud FM (1977) Regulation of total and regional spinal cord blood flow. Circ Res 41(1):128–134. https://doi.org/10.1161/01.res.41.1.128CrossRefPubMed

Titel: Surgical strategy for non-continuous thoracic spinal stenosis: one- or two-stage surgery?
verfasst von: Longjie Wang
Hui Wang
Zhongqiang Chen
Chuiguo Sun
Weishi Li
Publikationsdatum: 11.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 7/2021
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04913-2

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Surgical strategy for non-continuous thoracic spinal stenosis: one- or two-stage surgery?

Abstract

Purpose

Methods

Results

Conclusion

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2021

Comment on Eminovic et al. “Malnutrition as predictor of poor outcome after total hip arthroplasty”

Changes in pain catastrophization and neuropathic pain following operative stabilisation for patellofemoral instability: a prospective study with twelve month follow-up

Minimum ten-year results in revision total hip arthroplasty using titanium fully porous long stem

Response to the letter by Yao H. et al. on the article: “Evidence on ankle injections for osteochondral lesions and osteoarthritis: a systematic review and meta-analysis”

Comparison of “Bilboquet” device and locking plate for surgical treatment of proximal humerus complex fractures at two years follow-up

Comment on “Combined use of tranexamic acid and rivaroxaban in posterior lumbar interbody fusion safely reduces blood loss and transfusion rates without increasing the risk of thrombosis-a prospective, stratified, randomized, controlled trial”

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie