Role of lordotic rod contouring in thoracic myelopathy: a technical note

INTRODUCTION: Decompressive surgery for thoracic myelopathy due to anterior pathology can be challenging. Direct decompression through anterior approaches is associated with approach-related complications, whereas anterior decompression through posterior approaches is technically demanding and may result in neurological deterioration. We present a simple and effective surgical technique of indirect decompression through lordotic rod contouring to reduce such complications. CASE PRESENTATION: Patients who presented to our center between March 2016 and March 2017 with symptoms and signs suggestive of thoracic myelopathy predominantly due to anterior pathologies such as ossification of the thoracic posterior longitudinal ligament, posterior bony spur, and thoracic disc herniation were evaluated in our study. The indications for surgical treatment were progressive neurological impairment and severe myelopathy (grade III or more on Nurick grade). Only those patients classified as grade III and above on American Society of Anaesthesiologists (ASA) physical status scale were included in the study. All the cases were operated by a single surgeon by a posterior-only approach. We have used this technique in four patients with thoracic myelopathy due to combined or predominant anterior pathology. Postoperative imaging confirmed adequate decompression of the spinal cord. All the cases improved substantially in terms of clinical outcome. DISCUSSION: This surgical technique could be a useful alternative to direct anterior decompression in patients who present with symptoms of progressive severe myelopathy due to anterior compression and could be the standard of care in those at high risk for major surgery.