Diagnosis and one stage surgical treatment of lower thoracic ossification of ligamentum flavum combined with lumbar spinal stenosis / 中华骨科杂志

ABSTRACT

Objective To study the diagnosis and treatment of lower thoracic ossification of ligamentum flavum(OLF)combined with lumbar spinal stenosis.Methods Retrospective analysis was carried out on 11 cases of lower thoracic OLF combined with lumbar spinal stenosis.There were 4 males and 7 females,with an average age of 56 years,and the average course of disease was 42 months.From March 2007 to March 2009,all patients undergone thoracic and lumbar laminectomy and posterior-lateral fusion in one stage.Oswestry disability index(ODI)was used to assess the neurological functional status,visual analogue score(VAS)was recorded to assess low back pain,and Cobb's angle was used to evaluate the change of thoracolumbar kyphosis.Results Operation time was 200 to 450 min,with an average of 273 min;blood loss was 600 to 1800 ml,averaged 954 ml.There were two cases of cerebrospinal fluid leakage.Eleven cases were followed up for 13 to 36 months,with an average of 23.7 months,Preoperative VAS,Oswestry score and Cobb's angle was 7.91±0.83,66.36%±10.91%,5.91°±0.83° respectively.Postoperative VAS,ODI and Cobb's angle at the final follow-up was 2.18±1.90,25.45%±12.19% and 12.18°±3.06° respectively.VAS and ODI were significantly decreased after operation.The Cobb's angle was significant increased after operation,resulting in pathologic thoracolumbar kyphosis.Conclusion The clinical features of lower thoracic OLF are complicated,which may result in misdiagnosis if the thoracic OLF is accompanied with lumbar spinal stenosis.It is an optimal selection for lower thoracic OLF combined with lumbar spinal stenosis to resect lower thoracic and lumbar lamina in one stage.For females with osteoporosis,additional internal fixation in lower thoracic spine is necessary.