title: [Anterior decompression of the thoracic spine through the posterior approach: its usefulness, indications, technique, and the preservation of postoperative spinal stability].
abstract: Three patients with thoracic myelopathy were operated on using a modified surgical approach, anterior decompression of the thoracic cord through the posterior approach. The usefulness of and indication for this approach were discussed. Operative technique is as follows. In the prone position, laminae are removed widely enough to include the medial half of the facets and pedicles. This creates cavities lateral to the dural sac as deep as the diameter of the spinal canal. Through these cavities the anterior wall of the spinal canal and the posterior portion of the intervertebral disc are drilled out to make a space into which lesions are pulled away from the dural sac. The lesions can be removed under direct vision with minimum retraction to the dural sac. Our technique preserves the integrity of the spinous processes and supra/inter spinal ligaments, which do not restrict access to the cord and have the potential to be one of the supports of the spine. Postoperative course was uneventful in all of the patients. This approach has several advantages. It can be applied to any levels of the thoracic spine and can be used for decompression all around the thoracic cord. The procedure is minimumly invasive. The indications for this operation are considered to be 1) lesions at the level of T3, 2) anterior lesions associated with OYL at the same or adjacent level, 3) multilevel lesions which need staged operations, 4) laterally protruded discs and 5) lesions in elderly or high risk patients.
authors.affiliation: Department of Neurosurgery, Iwakuni National Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Nishiura
authors.forename: N
authors.initials: N
authors.lastname: Hagihara
authors.forename: T
authors.initials: T
authors.lastname: Masaoka
authors.forename: I
authors.initials: I
authors.lastname: Miyata
authors.forename: H
authors.initials: H
authors.lastname: Ishimitsu
authors.forename: Y
authors.initials: Y
authors.lastname: Harada
mesh_terms: D002818:Cordotomy / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D013115:Spinal Canal; D013118:Spinal Cord Diseases / Q000601:surgery*