Clinical Characteristics Of Lumbar Spinal Stenosis Combined With Ossification Of The Ligamentum Flavum Of The Thoracic Spine And Factors Influencing Surgical Efficacy

Objective:To analyze the clinical characteristics of patients with lumbar spinal stenosis combined with ossification of the yellow ligament of the thoracic spine,and to discuss the factors influencing surgical treatment and surgical efficacy.Methods : Retrospective analysis of 2900 patients with lumbar spinal stenosis hospitalized from January 2016 to December 2021 at the First Affiliated Hospital of Dali University was performed to count the incidence and distribution of patients with lumbar spinal stenosis combined with ossification of the ligamentum flavum of the thoracic spine.Based on the inclusion and exclusion criteria,98 patients with lumbar spinal stenosis combined with ossification of the thoracic ligament were included,and were divided into 1.23 patients in the combined thoracolumbar spine surgery group(group C)(12 in the combined first-stage surgery group(group C1)and 11 in the combined second-stage surgery group(group C2))according to the surgical procedure.2.28 patients in the thoracic spine surgery only group(group T).3.47 patients in the lumbar spine surgery only group(group L).The Japanese Orthopaedic Association(JOA)score and the Oswestry disability index(ODI)of the lumbar spine were used to assess the neurological status of the patients.The efficacy of group C was compared with group T;the efficacy of group C1 was compared with group C2;and the efficacy of group L was compared preoperatively and postoperatively.A total of 51 patients in groups C and T were divided into good or poor prognosis groups according to the postoperative JOA recovery rate of ≥50% or <49%,and gender,age,duration of symptoms,preoperative thoracic JOA score,degree of thoracic ligamentous ossification compressing the spinal cord(Moon classification),MRIT2 sagittal ossification morphology(bird’s beak type,round type),CT transverse ossification morphology(unilateral type,bilateral type,and bridging type)were correlated to analyze the factors affecting poor prognosis,and then binary logistic regression analysis was applied.Results:1.Of the 2900 patients with low back pain,2050 were diagnosed with lumbar stenosis and 228/2050(11.21%)were combined with ossification of the ligamentum flavum of the thoracic spine,and T9/T10 to T12/L1 were the most commonly involved segments with ossification of the ligamentum flavum.2.The mean follow-up time in the C1 group was 37.54±8.79 months The mean follow-up time in the C2 group was 37.27±7.46 months and 43.97±12.04 months in the T group.No significant differences were found between the groups in terms of gender,age,intraoperative bleeding,duration of preoperative symptoms,VAS score,preoperative thoracic JOA score,and preoperative ODI statistics(P>0.05),and the C1 group The operative time was less than that of the C2 operative group(P < 0.05).no statistically significant differences in symptoms were found between the C1 group,C2 group,and T group.3.In the intra-group comparison between groups C and T,both groups C and T showed significantly higher thoracic spine JOA scores at the last follow-up(P <0.05).The thoracic spine JOA at the last follow-up was higher in group C than in group T(P > 0.05),and the VAS scores and ODI scores at the last follow-up were lower in group C than in group T(P < 0.05).The improvement rate of thoracic spine JOA was 67± 27% in group C and 62 ± 24% in group T(P > 0.05).The improvement rate was62±24%,(P>0.05).4.The mean operative time in group C1 was significantly shorter than that in group C2(P < 0.05).preoperative thoracic JOA score in group C1 was smaller than that in group C2,and preoperative ODI score in group C1 was greater than that in group C2(P > 0.05).The thoracic JOA score at the final follow-up was greater in the C1 group than in the C2 group,and the thoracic ODI at the final follow-up was less in C1 than in C2(P > 0.05).The improvement rate of JOA in the C1 group was(59.90 ± 36.16)%,and that in the C2 group was(52.12 ± 33.44)%.5,The follow-up duration of group L was 30-60 months,with a mean of(43.80±9.39)months.The preoperative and final follow-up lumbar JOA scores and ODI were significantly higher(P < 0.05),and the improvement rate of lumbar JOA was67.76 ± 26.74%.6.There was a significant correlation between preoperative JOA score and postoperative outcome,while the correlation between age,lesion segment,BMI,duration of symptoms,degree of thoracic ligamentum flavum ossification compressing the spinal cord(Moon classification),MRIT2 sagittal plane ossification morphology(bird’s beak type,round type),CT transverse plane ossification morphology(unilateral type,bilateral type,bridging type)and postoperative outcome was not statistically significant.Conclusion:1.Preoperative low thoracic JOA score is an independent risk factor for poor prognosis of lumbar spinal stenosis combined with ossification of the yellow ligament of the thoracic spine,early diagnosis is the key to avoid serious spinal cord injury,and early surgical treatment should be performed.2,The postoperative hospital stay is longer for staged surgery,because the neurological function is restored in two stages during staged surgery.3.Simultaneous or staged surgery for lumbar spinal stenosis with ossification of the yellow ligament of the thoracic spine can achieve satisfactory clinical results.