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Long-Term (>Five Years) Surgical Outcome of Thoracic Myelopathy Due to Ossification of Ligamentum Flavum
116S
Proceedings of the NASS 27th Annual Meeting / The Spine Journal 12 (2012) 99S–165S
position, and posterior approach of thoracic spine was performed. A unilateral laminectomy and medial facetectomy are performed. The dissection of the intraspinal component must be performed first, to free the tumor from its relation to the cord. Next, en block resection was performed without severe traction on the anteriorly released tumor. We treated 21 patients using this technique RESULTS: None experienced complications attributable to the surgical technique. Also, the neurologic complications like Horner’s syndrome or radiating pain of the upper extremities were absent at least for 24 months follow-up. The results of biopsy were neurofibroma (12 cases), schwannoma (9 cases). No recured cases in final follow up. CONCLUSIONS: Video-assisted thoracoscpic anterior release followed by hemilaminectomy and medial facetectomy may be a good operative option for the resecting thoracic dumbbell tumors, especially for the means of ‘‘en bloc resection’’. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.312
P39. Long-Term (OFive Years) Surgical Outcome of Thoracic Myelopathy Due to Ossification of Ligamentum Flavum Chuiguo Sun, MD, Zhongqiang Chen, MD; Peking University Third Hospital Department of Orthopaedics, Beijing, China BACKGROUND CONTEXT: The long-term surgical outcome of thoracic myelopathy caused by the ossification of the ligamentum flavum (OLF) has not been fully investigated. PURPOSE: To present the long-term outcome and also evaluate the related risk factors, the authors reviewed medical records of patients who underwent decompressive surgery for thoracic OLF. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Forty-four patients underwent decompressive surgery for thoracic OLF (more than 5 years follow-up) were recruited. OUTCOME MEASURES: The surgical outcome was measured with JOA score method and modified Epstein method (4 classes: excellent, good, fair, poor). METHODS: Patients age, durations of symptoms, decompressed levels, dural leak, and the rate of excellent or good were reviewed. And the risk factors were analyzed statistically. RESULTS: The mean follow-up period of these 44 cases was 8.5 years (5~19 years). The postoperative short-term outcome was relatively good, the rate of excellent or good was77.3% (34/44), while the long-term result of the rate of excellent or good was 65.9% (29/44). There was one case suffered from a spinal cord injury after a car accident and got a poor postoperative outcome, and the other 43 cases had chronic durations, including 22 cases with pre-operative durations of symptoms less than twelve months and 21 cases with durations more than twelve months. And their long-term results were different from each other, while the rates of excellent or good of those whose durations were less than twelve months and those whose durations were more than twelve months were 77.3% (17/22) and 57.1% (12/21) respectively (PO0.05). The rate of excellent or good of those whose decompressed levels were limited in the area of T1-T9 was 78.9% (15/19), while that of the cases who underwent thoracolumbar segmental (T10-L2) decompression was 58.3% (14/24) (PO.05). There were 7 cases with good short-term results and poor long-term outcomes. The reasons of these changes included coexistence of lumbar spinal stenosis in three cases and the growth of the OLF at the adjacent undecompressed levels in four cases. CONCLUSIONS: Although the short-term results of the decompressive surgery for thoracic OLF was satisfied, the long-term follow-up results showed the symptoms may reoccur or deteriorate secondary to lumbar spinal stenosis or the growth of OLF at the adjacent levels near former
decompressive levels; the duration of symptoms more than one year and the decompressive levels involved T10-L2 were possibly related to the poor long-term outcomes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.313 P40. The Relationship of Symptomatic Thoracolumbar Disc Herniation and Scheuermann’s Disease Ning Liu, MD, Zhongqiang Chen, MD, Qiang Qi, MD; Peking University Third Hospital Department of Orthopaedics, Beijing, China BACKGROUND CONTEXT: Symptomatic disc herniations at thoracolumbar junction levels between T10/11 and L1/2 can be collectively called thoracolumbar disc herniation (TLDH). The etiology of this disorder is unclear. Furthermore, symptomatic TLDH is rare enough that its frequent occurrence with another spinal disorder (Scheuermann’s disease, SD) warrants investigation. Although the simultaneous occurrence of symptomatic TLDH and SD has been observed previously, the limited number of cases reported makes it difficult to investigate the relationship between them that may explain the etiology of symptomatic TLDH. PURPOSE: To investigate the relationship between symptomatic TLDH and SD in a TLDH cohort. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Cohort of 63 consecutive patients with symptomatic TLDH who had surgery between June 2006 and June 2011. OUTCOME MEASURES: Incidences of associated SD and its radiographic signs (Schmorl’s node (SN), irregular end-plate, posterior bony avulsion of the vertebra (PBA) and wedge-shaped vertebra) in the symptomatic TLDH patients, average thoracolumbar kyphotic angle and incidences of disc herniation at segments with and without radiographic signs of SD. METHODS: Data from the TLDH series were compared with 57 patients undergoing surgery for lower lumbar disc herniation (LDH, L3/4–L5/S1) in the same period. Incidences of radiographic signs of SD across all levels between T10/11 and L5/S1 were compared in the TLDH and LDH groups. SD was diagnosed either by the classical criteria of Sorenson of having at least three consecutive wedge-shaped vertebrae showing more than 5 of anterior wedging or, in cases who did not fulfill Sorenson’s criteria, by a modified Heithoff’s criteria for ‘‘atypical SD’’. Incidences of associated SD in both groups were examined. RESULTS: The incidences of radiographic signs of SD (SN, irregular endplate, PBA and wedge-shaped vertebra) were all higher in the TLDH group than in the LDH group. Of the TLDH patients, 95.2% had associated SD, whereas the incidence of SD in LDH patients was only 17.5% (P50.000). The average thoracolumbar kyphotic angle of TLDH patients was 16.9 , while that of the LDH group was 7.6 (P50.000). In the TLDH group, the incidences of disc herniation at segments with SN, irregular end-plate, PBA and wedge-shaped vertebra were all higher than at segments where no sign of SD was found. Particular attention was given to the high incidence (85.7%) of PBA in TLDH patients and high incidence (96.8%) of disc herniation at segments with PBA. CONCLUSIONS: Radiographic signs of SD (SN, irregular end-plate, PBA and wedge-shaped vertebra) are commonly seen in symptomatic TLDH patients. Although it would be arbitrary to suggest that symptomatic TLDH in general is a form of SD, the high proportion of associated SD in symptomatic TLDH patients suggests a close relationship between these two disorders. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.314
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 27th Annual Meeting / The Spine Journal 12 (2012) 99S–165S
position, and posterior approach of thoracic spine was performed. A unilateral laminectomy and medial facetectomy are performed. The dissection of the intraspinal component must be performed first, to free the tumor from its relation to the cord. Next, en block resection was performed without severe traction on the anteriorly released tumor. We treated 21 patients using this technique RESULTS: None experienced complications attributable to the surgical technique. Also, the neurologic complications like Horner’s syndrome or radiating pain of the upper extremities were absent at least for 24 months follow-up. The results of biopsy were neurofibroma (12 cases), schwannoma (9 cases). No recured cases in final follow up. CONCLUSIONS: Video-assisted thoracoscpic anterior release followed by hemilaminectomy and medial facetectomy may be a good operative option for the resecting thoracic dumbbell tumors, especially for the means of ‘‘en bloc resection’’. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.312
P39. Long-Term (OFive Years) Surgical Outcome of Thoracic Myelopathy Due to Ossification of Ligamentum Flavum Chuiguo Sun, MD, Zhongqiang Chen, MD; Peking University Third Hospital Department of Orthopaedics, Beijing, China BACKGROUND CONTEXT: The long-term surgical outcome of thoracic myelopathy caused by the ossification of the ligamentum flavum (OLF) has not been fully investigated. PURPOSE: To present the long-term outcome and also evaluate the related risk factors, the authors reviewed medical records of patients who underwent decompressive surgery for thoracic OLF. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Forty-four patients underwent decompressive surgery for thoracic OLF (more than 5 years follow-up) were recruited. OUTCOME MEASURES: The surgical outcome was measured with JOA score method and modified Epstein method (4 classes: excellent, good, fair, poor). METHODS: Patients age, durations of symptoms, decompressed levels, dural leak, and the rate of excellent or good were reviewed. And the risk factors were analyzed statistically. RESULTS: The mean follow-up period of these 44 cases was 8.5 years (5~19 years). The postoperative short-term outcome was relatively good, the rate of excellent or good was77.3% (34/44), while the long-term result of the rate of excellent or good was 65.9% (29/44). There was one case suffered from a spinal cord injury after a car accident and got a poor postoperative outcome, and the other 43 cases had chronic durations, including 22 cases with pre-operative durations of symptoms less than twelve months and 21 cases with durations more than twelve months. And their long-term results were different from each other, while the rates of excellent or good of those whose durations were less than twelve months and those whose durations were more than twelve months were 77.3% (17/22) and 57.1% (12/21) respectively (PO0.05). The rate of excellent or good of those whose decompressed levels were limited in the area of T1-T9 was 78.9% (15/19), while that of the cases who underwent thoracolumbar segmental (T10-L2) decompression was 58.3% (14/24) (PO.05). There were 7 cases with good short-term results and poor long-term outcomes. The reasons of these changes included coexistence of lumbar spinal stenosis in three cases and the growth of the OLF at the adjacent undecompressed levels in four cases. CONCLUSIONS: Although the short-term results of the decompressive surgery for thoracic OLF was satisfied, the long-term follow-up results showed the symptoms may reoccur or deteriorate secondary to lumbar spinal stenosis or the growth of OLF at the adjacent levels near former
decompressive levels; the duration of symptoms more than one year and the decompressive levels involved T10-L2 were possibly related to the poor long-term outcomes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.313 P40. The Relationship of Symptomatic Thoracolumbar Disc Herniation and Scheuermann’s Disease Ning Liu, MD, Zhongqiang Chen, MD, Qiang Qi, MD; Peking University Third Hospital Department of Orthopaedics, Beijing, China BACKGROUND CONTEXT: Symptomatic disc herniations at thoracolumbar junction levels between T10/11 and L1/2 can be collectively called thoracolumbar disc herniation (TLDH). The etiology of this disorder is unclear. Furthermore, symptomatic TLDH is rare enough that its frequent occurrence with another spinal disorder (Scheuermann’s disease, SD) warrants investigation. Although the simultaneous occurrence of symptomatic TLDH and SD has been observed previously, the limited number of cases reported makes it difficult to investigate the relationship between them that may explain the etiology of symptomatic TLDH. PURPOSE: To investigate the relationship between symptomatic TLDH and SD in a TLDH cohort. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Cohort of 63 consecutive patients with symptomatic TLDH who had surgery between June 2006 and June 2011. OUTCOME MEASURES: Incidences of associated SD and its radiographic signs (Schmorl’s node (SN), irregular end-plate, posterior bony avulsion of the vertebra (PBA) and wedge-shaped vertebra) in the symptomatic TLDH patients, average thoracolumbar kyphotic angle and incidences of disc herniation at segments with and without radiographic signs of SD. METHODS: Data from the TLDH series were compared with 57 patients undergoing surgery for lower lumbar disc herniation (LDH, L3/4–L5/S1) in the same period. Incidences of radiographic signs of SD across all levels between T10/11 and L5/S1 were compared in the TLDH and LDH groups. SD was diagnosed either by the classical criteria of Sorenson of having at least three consecutive wedge-shaped vertebrae showing more than 5 of anterior wedging or, in cases who did not fulfill Sorenson’s criteria, by a modified Heithoff’s criteria for ‘‘atypical SD’’. Incidences of associated SD in both groups were examined. RESULTS: The incidences of radiographic signs of SD (SN, irregular endplate, PBA and wedge-shaped vertebra) were all higher in the TLDH group than in the LDH group. Of the TLDH patients, 95.2% had associated SD, whereas the incidence of SD in LDH patients was only 17.5% (P50.000). The average thoracolumbar kyphotic angle of TLDH patients was 16.9 , while that of the LDH group was 7.6 (P50.000). In the TLDH group, the incidences of disc herniation at segments with SN, irregular end-plate, PBA and wedge-shaped vertebra were all higher than at segments where no sign of SD was found. Particular attention was given to the high incidence (85.7%) of PBA in TLDH patients and high incidence (96.8%) of disc herniation at segments with PBA. CONCLUSIONS: Radiographic signs of SD (SN, irregular end-plate, PBA and wedge-shaped vertebra) are commonly seen in symptomatic TLDH patients. Although it would be arbitrary to suggest that symptomatic TLDH in general is a form of SD, the high proportion of associated SD in symptomatic TLDH patients suggests a close relationship between these two disorders. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.314
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.