Cargando…

Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes

OBJECTIVE: Advanced biportal endoscopic surgery techniques can be used to treat thoracic myelopathy secondary to ossification of the ligamentum flavum (OLF). This case series elaborates on a feasible biportal endoscopic technique for thoracic OLF removal and evaluates clinical and radiological outco...

Descripción completa

Detalles Bibliográficos
Autores principales: Kim, Ji Yeon, Ha, Ji Soo, Lee, Chang Kyu, Lee, Dong Chan, Hong, Hyun Jin, Choi, Su Yong, Park, Choon Keun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Spinal Neurosurgery Society 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10080434/
https://www.ncbi.nlm.nih.gov/pubmed/37016861
http://dx.doi.org/10.14245/ns.2346060.030
_version_ 1785020921879199744
author Kim, Ji Yeon
Ha, Ji Soo
Lee, Chang Kyu
Lee, Dong Chan
Hong, Hyun Jin
Choi, Su Yong
Park, Choon Keun
author_facet Kim, Ji Yeon
Ha, Ji Soo
Lee, Chang Kyu
Lee, Dong Chan
Hong, Hyun Jin
Choi, Su Yong
Park, Choon Keun
author_sort Kim, Ji Yeon
collection PubMed
description OBJECTIVE: Advanced biportal endoscopic surgery techniques can be used to treat thoracic myelopathy secondary to ossification of the ligamentum flavum (OLF). This case series elaborates on a feasible biportal endoscopic technique for thoracic OLF removal and evaluates clinical and radiological outcomes. METHODS: A biportal endoscopic posterior thoracic laminectomy was performed to remove the thoracic OLF. Surgical techniques have evolved from inside-out piecemeal removal methods to outside-in en bloc removal methods. Preoperative computed tomography was performed to analyze dural ossification and OLF types. Intraoperative videos were reviewed to observe dural ossification and to determine the surgical method. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) score. RESULTS: Clinical symptoms and neurological function improved markedly after surgery (JOA score, preoperative: 12.6 ± 1.0, final follow-up: 15.6 ± 1.2). The mean operation time per segment was not short (106.6 ± 38 minutes). At early experience stages, inside-out piecemeal decompression was used and it caused intraoperative spinal cord injury. However, outside-in en bloc decompression technique did not induce neural complications. Postoperative segmental instability and correlated mechanical back pain were not observed. CONCLUSION: The biportal endoscopic posterior thoracic approach is an attractive surgical option to treat thoracic spondylotic myelopathy secondary to OLF. Piecemeal inside-out decompression can induce irreversible spinal cord injury, especially in the early experience stages. Outside-in decompression is more efficient and safer than inside-out pattern procedures by minimizing dural manipulation. Nonetheless, this technique is technically demanding and should only be performed in selected patients after acquiring abundant experience with endoscopic spine surgeries.
format Online
Article
Text
id pubmed-10080434
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Korean Spinal Neurosurgery Society
record_format MEDLINE/PubMed
spelling pubmed-100804342023-04-08 Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes Kim, Ji Yeon Ha, Ji Soo Lee, Chang Kyu Lee, Dong Chan Hong, Hyun Jin Choi, Su Yong Park, Choon Keun Neurospine Original Article OBJECTIVE: Advanced biportal endoscopic surgery techniques can be used to treat thoracic myelopathy secondary to ossification of the ligamentum flavum (OLF). This case series elaborates on a feasible biportal endoscopic technique for thoracic OLF removal and evaluates clinical and radiological outcomes. METHODS: A biportal endoscopic posterior thoracic laminectomy was performed to remove the thoracic OLF. Surgical techniques have evolved from inside-out piecemeal removal methods to outside-in en bloc removal methods. Preoperative computed tomography was performed to analyze dural ossification and OLF types. Intraoperative videos were reviewed to observe dural ossification and to determine the surgical method. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) score. RESULTS: Clinical symptoms and neurological function improved markedly after surgery (JOA score, preoperative: 12.6 ± 1.0, final follow-up: 15.6 ± 1.2). The mean operation time per segment was not short (106.6 ± 38 minutes). At early experience stages, inside-out piecemeal decompression was used and it caused intraoperative spinal cord injury. However, outside-in en bloc decompression technique did not induce neural complications. Postoperative segmental instability and correlated mechanical back pain were not observed. CONCLUSION: The biportal endoscopic posterior thoracic approach is an attractive surgical option to treat thoracic spondylotic myelopathy secondary to OLF. Piecemeal inside-out decompression can induce irreversible spinal cord injury, especially in the early experience stages. Outside-in decompression is more efficient and safer than inside-out pattern procedures by minimizing dural manipulation. Nonetheless, this technique is technically demanding and should only be performed in selected patients after acquiring abundant experience with endoscopic spine surgeries. Korean Spinal Neurosurgery Society 2023-03 2023-03-31 /pmc/articles/PMC10080434/ /pubmed/37016861 http://dx.doi.org/10.14245/ns.2346060.030 Text en Copyright © 2023 by the Korean Spinal Neurosurgery Society https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kim, Ji Yeon
Ha, Ji Soo
Lee, Chang Kyu
Lee, Dong Chan
Hong, Hyun Jin
Choi, Su Yong
Park, Choon Keun
Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
title Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
title_full Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
title_fullStr Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
title_full_unstemmed Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
title_short Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
title_sort biportal endoscopic posterior thoracic laminectomy for thoracic spondylotic myelopathy caused by ossification of the ligamentum flavum: technical developments and outcomes
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10080434/
https://www.ncbi.nlm.nih.gov/pubmed/37016861
http://dx.doi.org/10.14245/ns.2346060.030
work_keys_str_mv AT kimjiyeon biportalendoscopicposteriorthoraciclaminectomyforthoracicspondyloticmyelopathycausedbyossificationoftheligamentumflavumtechnicaldevelopmentsandoutcomes
AT hajisoo biportalendoscopicposteriorthoraciclaminectomyforthoracicspondyloticmyelopathycausedbyossificationoftheligamentumflavumtechnicaldevelopmentsandoutcomes
AT leechangkyu biportalendoscopicposteriorthoraciclaminectomyforthoracicspondyloticmyelopathycausedbyossificationoftheligamentumflavumtechnicaldevelopmentsandoutcomes
AT leedongchan biportalendoscopicposteriorthoraciclaminectomyforthoracicspondyloticmyelopathycausedbyossificationoftheligamentumflavumtechnicaldevelopmentsandoutcomes
AT honghyunjin biportalendoscopicposteriorthoraciclaminectomyforthoracicspondyloticmyelopathycausedbyossificationoftheligamentumflavumtechnicaldevelopmentsandoutcomes
AT choisuyong biportalendoscopicposteriorthoraciclaminectomyforthoracicspondyloticmyelopathycausedbyossificationoftheligamentumflavumtechnicaldevelopmentsandoutcomes
AT parkchoonkeun biportalendoscopicposteriorthoraciclaminectomyforthoracicspondyloticmyelopathycausedbyossificationoftheligamentumflavumtechnicaldevelopmentsandoutcomes