| Objective To investigate the efficiacy of different treatments to thoracic stenosismyelopathy caused by different factors.Methods A retrospective analysis was performed in45patients who was owing tothoracic stenosis myelopathy caused by different factors between July2006and June2013.17paients received en bloc hemi-articular process laminectomy to treat thoracic stenosismyelopathy caused by ossification of the ligamentum flavum (OLF).There were9maleand8female patients,ranging from41to70years,with a mean of54.6years.The courseof disease was from6to55months,averaged （32.5±4.3） months.The lesions in upperthoracic (T1-T4) was5cases,in middle thoracic (T5-T8) was3cases, in lower thoracic(T9-T12) was9cases.For the patients with multi-level of ossification of the ligamentumflavum(≥3levels) or located in lower thoracic spine,we performed en bloc hemi-articularprocess total laminectomy and internal fixation，combined with bone graft between thetransverse proces,while for the patients with one level or two levels of ossification of theligamentum flavum in upper and middle thoracic spine,we only performed en bloc hemi-articular process total laminectomy.All the patients for whom we performed en bloc hemi-articular process total laminectomy with or without internal fixation had no ossification ofthe posterior longitudinal ligament in any level of thoracic spine, intramedullary space-occupying lesion,cervical spondylosis myelopathy or lumbar spinal stenosis.15patientsowing to thoracic stenosis myelopathy caused by ossification of the posterior longitudinalligament (OPLL) or thoracic disc herniation (TDH) received anterior approachdecompression bone graft internal fixation between July2006and June2013.There were10male and5female patients,ranging from43to65years,averaged51.5years. Thecourse of disease was from3to42months,averaged （27.5±3.2）months.The TDH wasin9cases,OPLL was in6cases.13patients received transfacet joint approachdecompression bone graft internal fixation between July2006and June2013.There were6male and7female patients,ranging from36～68years,mean56.5years.The course ofdisease was from8to50months,averaged （30.5±3.8）months.The TDH was in6cases,OPLL was in2cases,OPLLwith OLF was in3cases,TDH with OLF was in2cases.Operative time and blood loss were recorded intraoperatively.The neurologic statusand complications were assessed.The modified Japanese Orthopedic Association scoringsystem （11points）was used to evaluate neurologic status.The Cobb angle was appliedto describe the change on the kyphotic angle of lesions from preoperative to postoperativeto the last follow-up.Results The en bloc hemi-articular process laminectomy group: The operation time was100to260min, averaged (190±30.5) min,and the amount of the blood loss ranged from200to1370ml,averaged (570±121.8)ml.All the patients had no spinal cord injury andnerve root injury.Cerebrospinal fluid leakage occurred in4patients intraoperatively andhealed well after repair. One person had postoperative epidural hematoma,then underwentemergency treatment and had a good recovery.All the patients had been followed up for6～45months,averaged (23.5±8.5) months.The JOA score was improved from5.8±1.7preoperatively, to7.9±2.4at3months postoperatively,to8.3±2.5at the final follow-up,with a significant difference between preoperation and postoperation（P<0.05). Therecovery rate was38.5%,48.1%respectively. The local kyphosis in the treated area had no significant difference.The anterior approach decompression group: The operation timewas from210to320min, averaged (270±43.6) min,and the amount of blood loss rangedfrom1230to2300ml,averaged (1547±284.1) ml.Two cases had neurological deteriorationand received methylprednisolone ictus treatment.One person got some recovery,whilethe other people had no recovery.Five cases had the cerebrospinal fluid leakage. All thepatients had been followed up for10～35months,averaged (25.6±6.3) months.The JOAscore was4.9±2.7preoperatively,8.2±1.6at3months postoperatively,8.8±2.1at the finalfollow-up,with the recovery rate54.1%and63.9%respectively. There was significantdifference between pre-operation and post-operation（P<0.05).The local kyphotic anglein the treated area had significant difference between pre-operation and post-operation（P<0.05) and had no significant difference between three months after operation and thelast follow-up.The transfacet joint approach decompression group: The operation time was190to300min, averaged (225±22.4) min,and the amount of the blood loss ranged from750to2090ml,averaged (1069±213.6) ml.One case had neurological deterioration andreceived methylprednisolone ictus treatment and recovered nearly to the pre-operativelevel6months later.Three cases had the cerebrospinal fluid leakage and receivedconservative treatment including keeping the end of bed higher and a positive pressuredrainage.All the three people recovered well. All the patients had been followed up for18～47months,averaged36.9±7.6months.The JOA score was improved from4.5±1.2preoperatively, to7.3±2.4at3months postoperatively, to8.6±1.8at the final follow-up,with the recovery rate43.1%at three months,63.1%at the final follow-up. Thedifference between the3months postoperatively and the final follow-up was significant（P<0.05).The local kyphotic angle in the treated area had significant difference betweenpre-operation and post-operation（P<0.05) and had no significant difference between threemonths after operation and the last follow-up..Conclusion En bloc hemi-articular process laminectomy, with bone graft internalfixation on occasion, is a simple,effective therapeutic option for thoracic myelopathy dueto OLF,with a few complications. The anterior approach decompression bone graftinternal fixation is a effective treatment,but it takes a long time,loses more blood,has ahigh risk of complications.The transfacet joint approach decompression which is used totreat anterior compression or anterior and posterior compression,with a high recovery rateand a few complications,taking little time,losing litle blood,is a effective method to get afull decompression at one stage. |
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