Elsevier

World Neurosurgery

Volume 133, January 2020, Pages 135-141
World Neurosurgery

Technical Note
Posterior 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

https://doi.org/10.1016/j.wneu.2019.08.215Get rights and content

Background

The occurrence rate of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation is lower than that of ossified ligamentum flavum in the thoracic spine, and the treatment method has rarely been reported. In this paper, we applied an endoscopic technique to a patient with thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation at the T10–11 level.

Methods

We performed surgical decompression of the thoracic spinal cord for a patient diagnosed with thoracic spinal stenosis at the T10–11 level caused by ossification of the ligamentum flavum combined with disk herniation using percutaneous endoscopic surgery via the bilateral translaminar osseous channel approach. Pre- and postoperative computed tomography (CT) scan and magnetic resonance imaging (MRI) examinations were performed, and pre- and postoperative neurologic status was evaluated using the Modified Japanese Orthopaedic Association and visual analog scale scores.

Results

The ossified ligamentum flavum and herniated disk material were removed through this osseous channel. Postoperative CT and MRI scanning revealed adequate decompression of the spinal cord at the T10–11 level. The patient was discharged home on postoperative day 3. At 6-month postoperative follow-up, the patient experienced complete resolution of T12 dermatomal numbness. The strength in her bilateral lower extremities improved slightly to grade 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 ligamentum flavum combined with disk herniation. This surgery could provide sufficient decompression for thoracic spinal cord with minimum trauma.

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.

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