Thoracic Spinal Circumferential Decompression And Intervetebral Bone Graft Fusion With Pedicel Screw Internal Fixation In Treatment Of Thoracic Spinal Stenosis

Objective:To investigate the surgical therapy and efficiency of posterior medial aprroach via vetebral arch 360°circumferential decompression and intervetebral cage bone graft fusion by nail-stick internal fixation systerm on the first stage for thoracic spinal stenosis(TSS) with ossification of posterior longitudinal ligament(OPLL).Methords: Form October 2006 to Februry 2010, in sum 11 (T3～T10)TSS cases with OPLL were surgical treated, including 7 males and 4 females. Aged from 34 to 67 years (mean age 47.8±1.3years). 3 cases Monosegmental TSS, 5 cases two segments, 3 cases there segements.Four cases had upper thoracic spinal stenosisal(T1～T4). Two cases of them only had OPLL, Two cases of them had OLF and OPLL. AIl the other 7 eases had middle and/or lower (T5～T12)TSS with both OPLL and OLF. All patients had severe spinal cord compression from anterior and posterior. Four cases of them had OPLL and OLF. Three cases had OLF and TDH. These cases' low limbs were incomplete paralysis. All these cases were surgical treated by posterior medial aprroach via vetebral arch 360°circumferential decompression and intervetebral cage bone graft fusion by nai～stick internal fixation systerm:Fist,posterior decompression completed by removing the posterior wall of spinal canal. Then, zygapophysial joints was amputated. last, OPLL,TDH were removed.Posterior medial aprroach via vetebral arch 360°circumferential decompression and intervetebral cage bone graft fusion by nail-stick internal fixation was used in all cases.fixation. Lower limb funcfion results were evaluated using Mann classification, the preoperative Mann grade were gradeⅢin 6 cases. gradeⅣi n 4 cases and grade V in 1 cases. Spinal cord function results were evaluated by paraplegia index, the preoperative paraplegia index were 1 in 4 cases, 2 in 5 cases. 3 in 2 cases and 4 in 1 cases.Result: All cases' symptoms didn't aggravate after operation. All procedures were eventful with mean operation time of 150min. The average blood lose was 280ml. Cerebrospinal fluid leakage occurred in 2 cases. Epiduaral hematoma occurred in 1cases after 7 days of postoperation, which two low limbs' strength delined. But the sydrome improved after hematoma debridement in emergency operation and there was not infection. Poster～operative cases' neurologic function of the spinal cord was improved. the improvement of gradeI in 4 cases, gradeII in 5 cases, gradeIII in 2 cases.sification. The lower limb function relief rate was 100% after operation. Spinal cord function results were evaluated by paraplegia index. After operation, paraplegia index was 0 in 2 cases, 1 in 6 cases, 2 in 1 cases and 3 in 1 cases. All cases were followed up from 6 months to 4 years. Their two low limbs' strength impoved in diferent dgree. Usually muscl strength improve from 4 weeks to 8 weeks. The poster～operative Mann grade were gradeI in 6 cases. gradeII in 2 cases and gradeIII in 1 case. Paraplegia index at final fol1ow up was 0 in 10 cases. 1 in 1cases and 2 in 0case.Conclusion: Posterior medial aprroach via vetebral arch 360°circumferential decompression and intervetebral cage bone graft fusion by nail-stick internal fixation systerm on the first stage for thoracic spinal stenosis(TSS) with ossification of posterior longitudinal ligament(OPLL) is an effective safe and convenient operation without few complicating diseases,which avoid the damagement of lung on anterior approach.