RESUMO
Objective To explore the surgical strategies of thoracic spinal stenosis with dural ossification. Methods One-hundred and eight patients with thoracic spinal stenosis were treated. Dural ossification was found in 29 cases during operation from January 2004 to June 2008. There were 19 males and 10females, with an average age of 56.4 years (42-74 years). The course of disease was 13 months (2-48months). The lesion was located in T1-T4 in 4 cases, T5-T8 in 5 cases, and T9-T12 in 20 cases. All the patients were treated by posterior lamina resection. Both ossificated dural and ossificated yellow ligament were resected in 16 patients. Decompression was performed with partial ossification remaining on dural surface in 13 cases. JOA score was used to evaluate the outcomes 1, 3 and 12 months after operation. Results The average operation time was 140 min, and average bleeding was 300 ml. Dural incisions were repaired with a wound drainage in 11 cases. Seven cases appeared cerebrospinal fluid leakage which healed in 3-5 days.Dural incisions were not repaired without wound drainage in 5 cases. Cerebrospinal fluid leakage occurred in these cases healed in 5-7 days. Thirteen cases treated with floating method did not appear cerebrospinal fluid leakage. All patients did not undergo subarachnoid infection and the aggravation of original nervous system symptoms. According to JOA score, all patients were evaluated as excellent in 22 cases, good in 5 and fair in 2 cases, and excellent and good rate was 93%. Conclusion For thoracic spinal stenosis with dural ossification, resection of both ossificated dural and ossificated yellow ligament and complete decompression with partial ossification remaining on dural surface is safe and reliable. Dural ossification does not influence the prognosis, but increase operative difficulty and risk.
RESUMO
Objective To study the clinical features and surgical strategies of thoracic spinal stenosis caused by ossification of posterior longitudinal ligament(OPLL).Methods From January 2004 to March 2009,21 cases of thoracic spinal stenosis casued by OPLL,including 13 males and 8 females,received surgical treatments.Those cases aged from 34 to 71 years,with an average of 51.2 years old.The courses of disease were from 2 to 50 months,averaged 11 months.The lesions located in upper thoracic(T1-T4)for 4 cases,in middle thoracic(T5-T8)for 7 cases,in lower thoracic(T9-T12)for 10 cases.Nine cases were associated with ossification of ligamentum flavum(OLF),and 8 cases combined with cervical OPLL.Eleven cases received laminectomy and 10 cases received anterolateral decompression.Results The operation time was 90 to 240 min for posterior laminectomy with an average of 140 min,and 110 to 360 min for anterolateral decompression with an average of 240 min.All cases had no worse postoperative symptoms,neurological complications,subarachnoid cavity or wound infection.Japanese Orthopaedic Association(JOA)score was 8 to 15 with an average of 9.17±1.63 in 6 months after surgery.Nerve function improvement was excellent for 8 cases,good for 6 cases,fair for 5 cases and poor for 2 cases.The excellent and good rate was 66.7%.JOA score was 8-15,averaged 10.23±1.64,in 12 months after surgery.Nerve function improvement was excellent for 8 cases,good for 7 cases,fair for 4 cases,and poor for 2 cases.The excellent and good rate was 71.4%.Conclusion Thoracic spinal stenosis result from OPLL,which often combine with cervical OPLL and OLF,often show multiple manifestations.Posterior laminectomy and anterolateral decompression are suitable for those conditions.