Selection of surgical methods for thoracic ossification of ligamentum flavum combined with cervical spondylotic myelopathy

Objective To investigate the difference between 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

Diagnosis and one stage surgical treatment of lower thoracic ossification of ligamentum flavum combined with lumbar spinal stenosis

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

Laminar thinned-segmented decompression for treatment of thoracic ossification of ligamentum flavum with myelopathy

Objective To evaluate the effects of the laminar thinned-segmented decompression technique in the treatment of thoracic ossification of ligamentum flavum with spondylotic myelopathy.Methods From January 1999 to January 2009,126 cases

En bloc resection of semi-facet and lamina for thoracic ossification of ligamentum flavum with epidural adhesion

Objective To explore the strategy and outcomes of surgical treatment of thoracic ossification of ligamentum flavum(OLF),especially combined with ossification of posterior longitudinal ligament,thoracic kyphosis and epidural

Clinical results and intramedullary signal changes of posterior decompression with transforaminal interbody fusion for thoracic myelopathy caused by combined ossification of the posterior longitudinal ligament and ligamentum flavum

Background Surgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament （OPLL） and ossification of the ligamentum flavum （OLF） is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion （PTTIF） may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.

Spinal Cord Kinking in Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Background：Ossification of the ligamentum flavum （OLF） is being increasingly recognized as a cause of thoracic myelopathy.This study was to describe a rare clinical entity of spinal cord kinking （SK） in thoracic myelopathy secondary to OLF.Methods：The data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively.The incidence and location of SK were determined using preoperative magnetic resonance imaging （MRI）.The clinical presentation and radiological characteristics in patients with SK were analyzed.Posterior en bloc laminectomy with OLF was performed,and the surgical results were evaluated.Results：SK was found in seven patients （7.4％） based on preoperative MRI.The patients included one male and six females with an average age of 55.6 years （range,48-64 years）.Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis.In all cases,the kinking was located just above the end of the spinal cord where the conus medullaris （CM） was compressed by the OLF.The degree of SK varied from mild to severe.The tip of the CM was located between the upper third of T1 1 to the lower third of L 1,above the lower edge of L 1.With an average follow-up of 30.4 months,the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively （t =12.05;P ＜ 0.0001） with an improvement rate of 63.1 ± 12.3％.Conclusions：SK is a rare radiological phenomenon.It is typically located at the thoracolumbar junction,where the CM is compressed by the OLF.Our findings indicate that these patients may benefit from a posterior decompressive procedure.

Thoracolumbar surgery for degenerative spine diseases complicated with tethered cord syndrome:A case report

BACKGROUND Tethered cord syndrome(TCS) secondary to split cord malformation(SCM) is rare in adulthood.There is as yet no consensus about the optimal treatment method for adult patients with SCMs and degenerative spine diseases such as lumbar stenosis,spondylolisthesis and ossification of the ligamentum flavum(OLF).The tethered cord poses a great challenge to the decompression and fusion procedures for the intraoperative stretching of the spinal cord,which might lead to deteriorated neural deficits.Here,we report on a case to add our treatment experience to the medical literature.CASE SUMMARY We treated a 67-year-old female patient with type II SCM suffering from lumbar disc herniation,degenerative lumbar spondylolisthesis and thoracic OLF.The patient underwent thoracolumbar spinal fusion and decompression surgery for severe lower back pain,extensive left lower limb muscle weakness and intermittent claudication.After the thoracolumbar surgery,without stretching the tethered cord,the patient achieved complete relief of pain and lower extremity weakness at final follow-up.CONCLUSION For adult patients with underlying TCS secondary to SCM coupled with thoracic OLF and lumbar spondylolisthesis,a thoracolumbar fusion surgery could be safe and effective with the tethered cord untreated.It is critical to design individualized surgical protocols to reduce the stretch of the low-lying spinal cord.