title: Surgical strategies for ossified ligamentum flavum associated with dural ossification in thoracic spinal stenosis.
abstract: We describe two surgical strategies for treating thoracic spinal stenosis (TSS) with ossification of the ligamentum flavum (OLF) and dural ossification (DO), and discuss their postoperative efficacy. From January 2004 to June 2008, 147 patients underwent TSS surgery. Thirty three of those with intraoperative evidence of OLF and DO were included in the present study. Based on the different intraoperative treatment of the dura, these 33 patients were divided into two groups: Group A, 17 patients who had their dura slit and the ossification excised, and Group B, 16 patients treated by floating the ossified dura by thinning it with a drill. All patients underwent outpatient follow-up. Pre- and postoperative Japanese Orthopaedic Association (JOA) scores and recovery rates were evaluated. The mean follow-up period was 42 months. The incidence of DO with OLF in TSS was 22%. At 1 year follow-up, the mean JOA score improved from 5.12 ± 1.17 to 6.94 ± 0.90 in Group A and from 5.25 ± 1.34 to 7.13 ± 1.41 in Group B. Additionally, the mean JOA score improved from 5.18 ± 1.24 to 7.03 ± 1.16 in TSS patients with DO and from 5.52 ± 1.21 to 7.21 ± 1.18 in TSS patients without DO. The increased cross-sectional area of the pre- and postoperative dural sac at the level of stenosis suggested that decompression was complete. Both decompression methods are feasible for curing TSS with OLF and DO. Moreover, slitting the dura for ossified dura and ligamentum flavum removal to relax the spinal cord is a safe and reliable method. Even though it increased the surgical difficulties and risks, DO did not affect postoperative neurological recovery.
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Heping District, Anshan Road 154, Tianjin 300052, PR China.
authors.forename: Jingcheng
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Heping District, Anshan Road 154, Tianjin 300052, PR China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Heping District, Anshan Road 154, Tianjin 300052, PR China.
authors.forename: Guangzhi
authors.initials: G
authors.lastname: Ning
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Heping District, Anshan Road 154, Tianjin 300052, PR China.
authors.forename: Yulin
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Heping District, Anshan Road 154, Tianjin 300052, PR China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Heping District, Anshan Road 154, Tianjin 300052, PR China.
authors.forename: Pei
authors.initials: P
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin Heping District, Anshan Road 154, Tianjin 300052, PR China. Electronic address: fengsq321@gmail.com.
authors.forename: Shiqing
authors.initials: S
authors.lastname: Feng
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy; D017843:Ligamentum Flavum / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
keywords: Dura mater; Myelopathy; Ossification; Ossification of the ligamentum flavum; Thoracic spinal stenosis