Selection of the surgical methods for the thoracic ossification of ligamentum flavum combined with cervical spondylotic myelopathy / 中华骨科杂志

ABSTRACT

Objective To investigate the difference between the different surgical methods for thoracic ossification of ligamentum flavum(OLF)combined with cervical spondylotic myelopathy(CSM).Methods From January 1991 to January 2003,56 cases with thoracic OLF combined with CSM were reviewed retrospectively.Forty of 56 cases had been followed up for more than two years.There were 22 males and 18 females with an average of 58 years(range,27-70 years).The course of the diseases were 1 to 120 months,with an average of 16.5 months.The pathological factors for thoracic myelopathy includedOLF for 25 cases,OLF combined with ossification of posterior longitudinal ligament(OPLL)for 12 cases,OLF combined with thoracic disc herniation for 3 cases.There were 23 cases combined with cervical OPLL and 17 cases combined with cervical stenosis.Eighteen cases underwent cervical laminoplasty and thoracic laminectomy,9 cases underwent only thoracic laminectomy,and 13 cases underwent both cervical and thoracic posterior decompression in multiple stages.Results Forty cases were followed up for 24 to 227 months,with an average of 67.5 months.According to Epstein standard,the excellent and good rate was 88.9% for 18 cases who underwent cervical laminaplasty and thoracic laminectomy(16/18),66.7% for 9 cases who underwent only thoracic laminectomy(6/9),and 53.8% for 13 cases who underwent both cervical and thoracic posterior decompression(7/13).Statistics analysis showed that the outcome of one-stage surgery was better than multiple stages surgeries,and outcome of those whose operation intervals less than 1 year was better than those of more than 1 year.Conclusion Thoracic and cervical decompression should be performed at one stage for those with upper thoracic OLF combined with CSM.Thoracic decompression should be performed firstly for those with severe lower extremities syndrome and few upper extremities syndrome.Thoracic and cervical decompression in one or multiple stages should be performed for those with severe upper and lower extremities syndrome,and operation interval should be less than one year.