Objective To identify the surgical indications, clinical outcomes and anatomical basis of one stage posterior approach encircle method for resection of thoracic ossification of ligamentum flavum (TOLF). Methods From January 2010 to June 2018, 20 TOLF cases admitted in our department were selected according to following indications: 1) the first diagnosis was TOLF; 2) fused type and tuberous type of Sato classification was excluded. 3) dural ossification signs showed on CT scans were excluded. 4) patients with the ossified mass occupation rate more than 55% was excluded. Preoperative and last follow-up modified JOA score, anatomy profiles, operative time, bleeding amount, complications were recorded and retrospectively analyzed. Results Twenty cases were collected, there were 9 males and 11 females, average age was 55.2 years old (43~75 years old). All cases were successful managed by one stage posterior approach for encircle method for resection of thoracic ossification of ligamentum flavum. There were 36 segments totally. Average operative time was 116 minutes per segment. Bleeding amount was 131ml on average. There was 1 case in cerebrospinal fluid leakage. After suture was preformed, the patient recovered without any complication. All cases were successfully followedup for 48 to 54 months, with an average of 50.9 months. Preoperative modified JOA score was (7.50±1.02), last follow-up score was (10.25±0.62), there was statistical difference between two groups (P<0.05). The postoperative recovery rate was 80.43% on average, 13 cases were evaluated as excellent, 7 case were evaluated as good. No symptom recurrence was observed. Conclusions After careful patient selection according to indications, encircle method for resection of thoracic ossification of TOLF could be carried out with a satisfied clinical outcome, simplified procedure, less auxiliary means, short operative time, few complication and good prognosis.
Key words
Thoracic spine /
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Ossification of the ligamentum flavum /
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Surgical indication /
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Anatomy /
Posterior approach /
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Free hand
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