Treatment of Thoracic Ossification of Posterior Longitudinal Ligament with One-Stage 360 Degree Circumferential Decompression Assisted by Piezosurgery.

OBJECTIVES: To evaluate the safety and clinical efficacy of One-Stage 360 degree circular decompression for thoracic ossification of the posterior longitudinal ligament (TOPLL) assisted by piezosurgery. MATERIALS AND METHODS: The present study enrolled 36 patients with TOPLL between August 2016 and February 2019. The average intraoperative bleeding volume of all 36 patients in this study is 1058.61 ±737.66 ml. RESULTS: All patients did not experience any intraoperative complications such as spinal cord and nerve injuries, and 22 other complications related to decompression of OPLL cited in other literature; all of which were relieved after treatment. The resection time of single laminectomy was 3.43 ±0.49 min, and circular decompression was 42.06 ±14.22 min. At the last follow-up, the modified Japanese Orthopaedic Association (mJOA) score was 8.89 ±1.56, the recovery rate of spinal cord function was 64.2 ±21.2%, and the number of cases of spinal cord function deterioration was 0 (0%). The mJOA score of the last follow-up was negatively correlated with the time of circular decompression (r = 0.368, p ＜ 0.01) and age (r = 0.412, p = 0.026). The recovery rate of the spinal cord function was negatively correlated with the operation time of circular decompression (r = -0.325, p = 0.041) and the amount of intraoperative blood loss (r = -0.555, p = 0.028). CONCLUSIONS: The use of piezosurgery can safely and effectively complete one-stage simple posterior TOPLL with 360-degree circular decompression. The incidence of complications is not high, and a good outcome can be obtained.

Three-dimensional navigation (O-arm) versus fluoroscopy in the treatment of thoracic spinal stenosis with ultrasonic bone curette: A retrospective comparative study.

Three-dimensional intraoperative navigation (O-arm) has been used for many years in spinal surgeries and has significantly improved its precision and safety. This retrospective study compared the efficacy and safety of spinal cord decompression surgeries performed with O-arm navigation and fluoroscopy. The clinical data of 56 patients with thoracic spinal stenosis treated from March 2015 to April 2017 were retrospectively analyzed. Spinal decompression was performed with O-arm navigation and ultrasonic bone curette in 29 patients, and with ultrasonic bone curette and fluoroscopy in 27 patients. Patients were followed-up at postoperative 1 month, 3 months, and the last clinic visit. The neurologic functions were assessed using the Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire. The accuracy of screw placement was examined using three-dimensional computed tomography (CT) on postoperative day 5. There was no significant difference in the incidences of intraoperative dural tear, nerve root injury, and spinal cord injury between the two groups. The two groups showed no significant difference in postoperative JOA scores (P > .05). The O-arm navigation group had significantly higher screw placement accuracy than the fluoroscopy group (P < .05). O-arm navigation is superior to fluoroscopy in the treatment of thoracic spinal stenosis with ultrasonic bone curette in terms of screw placement accuracy. However, the two surgical modes have similar rates of intraoperative complications and postoperative neurologic functions.

[Complication and treatment of the lumbar intervertebral disc herniation using percutaneous endoscopic lumbar discectomy].

OBJECTIVE: To summarize and discuss the lapsus and the treatment of the lumbar intervertebral disc herniation using percutaneous endoscopic lumbar discectomy (PELD). METHODS: Between July 2002 and October 2010, 689 patients with lumbar intervertebral disc herniation treated by PELD were analyzed, including 448 males, and 241 females. Single lumbar intervertebral disc herniation were 669 cases. double lumbar intervertebral disc herniation were 19; three lumbar intervertebral disc herniation were 1. Central type in 66, side central type in 365, lateral type in 242, extreme lateral type in 10, sequestered type in 6. These cases with complications in operation and postoperation were studied retrospectively. RESULTS: There were nucleus pulposus omissions in 5 patients and 2 patients underwent open resection of nucleus pulposus during operation immediately and the second operation was needed in 3 cases, 1 case with transforaminal lumbar interbody fusion (TLIF) and the others with open resection of nucleus pulposus. Two patients had nerve root injury, but all completely recovered in 3 - 6 months after operation. Spinal dura mater disruption was in 2 patients, recovered after suturing of skin wound. All 689 patients were followed up for 6 - 96 months, mean follow-up time was 33 months. Postoperative spondylodiscitis was in 7 patients, recovery after expectant treatment in 1, percutaneous puncture irrigation and drainage for continued use of local antibiotics in 4, posterior infective lumbar discectomy in 2. Postoperative relapse was in 6 patients, operated secondly by PELD in 4 and by TLIF in 2, recovery after the second operation. Nerve root induced hyperalgesia and burning-like nerve root pain was seen in 19 patients, the symptom was improved by analgesic drug, neurotrophy drug and physiotherapy. The effect of single segment PELD was not good in 10 patients with spinal stenosis, who underwent multiple segment TLIF later. CONCLUSIONS: The complications during operation usually are nucleus pulposus omissions, nerve root injury, spinal dura mater disruption. Accordingly the complications after operation include spondylodiscitis, recurrence, nerve root induced hyperalgesia or burning-like nerve root pain. Strict indication, aseptic technique, skilled operation and proper rehabilitation exercise are effective ways to reduce complications.