Technical NotePosterior Percutaneous Endoscopic Technique Through Bilateral Translaminar Osseous Channels for Thoracic Spinal Stenosis Caused by Ossification of the Ligamentum Flavum Combined with Disk Herniation at the T10–11 Level: A Technical Note
Section snippets
Materials and Methods
A 58-year-old woman exhibited neurologic symptoms in the bilateral lower extremities caused by compressive myelopathy because of T-OLF and TDH at the T10–11 level 3 months before surgery. The numbness and pain in the right lower extremity were more obvious than those sensations in the left lower extremity. She was treated conservatively for 2 months; however, her symptoms were not improved and deteriorated. She was unable to walk for >20 m because of bilateral leg fatigue and paresthesia,
Results
Postoperatively, the patient's numbness and pain in the bilateral lower extremities were alleviated. The strength in the patient's lower extremities improved slightly to 4+ out of 5 bilaterally. Postoperative CT and MRI scans revealed that the ossified LF and right dorsolateral herniated disk material were almost completely removed, which indicates an adequate decompression of her spinal cord at the T10–11 level (Figure 5). The VAS score improved from 8 to 5, and the mJOA score improved from 5
Discussion
T-OLF mainly occurs in Asian populations and is especially common in Japan and China.20 The diagnosis is commonly missed or delayed because of its insidious and chronic progression and the frequent presence of other spinal diseases. Most patients present with symptoms of back pain, numbness, and tingling in the lower extremities. Myelopathic signs such as gait disturbance and muscular hypertonia are also common. These symptoms always persist for at least 1 year before diagnosis.1, 4, 5
Conclusions
We have applied percutaneous endoscopic surgery via bilateral translaminar osseous channels for the treatment of thoracic spinal stenosis caused by ossification of the LF combined with disk herniation. This surgery could provide sufficient decompression for thoracic spinal cord with minimum trauma.
Acknowledgments
The authors thank Sheng Ye for the preparation of figures, and Fu-Jun Wu and Wang Xin for their help in preparation of the manuscript.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.