Double-level posterior spinal shortening for paralytic osteoporotic vertebral collapse of two vertebral bodies with a normal vertebra in between: a case report

Introduction  Spinal shortening is indicated for osteoporotic vertebral collapse. However, this surgical procedure has not been indicated for more than two vertebral levels that are not adjacent. We experienced a rare case of paraparesis due to osteoporotic vertebral collapse of two vertebral bodies with a normal vertebra in between and treated successfully by the double-level posterior shortening procedure. Materials and methods  A 79-year-old woman suffered from delayed paraparesis 2 years after L1 and Th11 vertebral body compression fracture. Plain X-ray photographs showed Th11 and L1 vertebral body collapse, Th7 compression fracture and a kyphosis angle of 30° from Th10 to L2. Plain magnetic resonance imaging showed spinal canal stenosis at Th11 and L1 vertebral body levels. She was treated by double-level posterior spinal shortening using pedicle screw and hook systems. Results  After the procedure, the patient’s kyphosis angle decreased to 10° and her back pain, leg pain, and sensory deficits improved. She was able to walk by herself. Although new vertebral compression fractures occurred at L4 and L5 in the follow-up period, there has been no deterioration of the neurological symptoms 5 years after the operation. Conclusion  Delayed paraparesis after double-level thoracolumbar vertebral collapse due to osteoporosis was treated successfully by double-level posterior spinal shortening using a pedicle screw and hook system.     

单纯后路经椎弓根截骨或脊椎切除的临床分析

目的探讨一期单纯后路经椎弓根脊柱截骨和脊椎切除操作的可行性和如何避免手术并发症的发生。方法回顾125例重度僵硬性脊柱畸形患者的临床资料,分析采用经椎弓根脊柱截骨技术或经椎弓根扩大蛋壳技术进行脊椎切除操作的可行性、手术时间、出血量、术中术后并发症。所有患者均采用经椎弓根内固定系统矫形固定。结果平均手术时间210min,术中失血平均1400ml。术中发生13例胸神经根损伤,术后无明显不适主诉。6例血气胸,经胸腔闭式引流治愈。6例硬膜撕裂,术后自然愈合。术后1例强直性脊柱炎患者腹部皮肤出现较大张力和水泡,经外敷硫酸镁2周治愈。1例术后发生伤口深部感染,经伤口清创冲洗,4周后治愈。1例发生截骨平面以下瘫痪,经脱水消炎治疗,4个月后完全恢复。并发症主要与初期手术操作有关,特别是椎体外侧壁和后壁截骨时,更易发生并发症。结论单纯后路经椎弓根脊柱截骨和脊椎切除操作简单,可行性好,明显缩短了手术时间,小心操作和掌握操作要点,能够避免手术并发症的发生。     

Experimental determination of the effect of progressive sharp-angle spinal deformity on the spinal cord

Neurological deficit is a serious though not well-known complication associated with spinal deformity. Sharp-angle kyphosis may be congenital, traumatic, degenerative, infectious, or iatrogenic in origin. Many kyphotic deformities are underestimated, thus leading to severe neurological deficit. In order to determine exactly what procedures of angulation the patients should undergo to stabilize the spine, which are major operations, the authors analyzed in an experimental model the effects of progressive sharp angulation on the anatomy of spinal canal and cord. We found that sharp anterior angulation of 50° causes ante rior-posterior stenosis and the dura will touch the spinal cord. At 90° of angulation, the spinal cord will be squeezed and the pressure in the canal will be double what it was initially, probably leading to ischemia. The experimental confirmation (determination) of these angulations allows the physician in charge to define early in the treatment program when a surgical stabilization procedure should be included, before the angulation causes any neurological damage.     

Minimally invasive ventral spondylodesis for thoracolumbar fracture treatment: surgical technique and first clinical outcome

A new instrumentation system for ventral stabilization of the spine that can be used for an endoscopic and minimally invasive approach was developed. We describe the implantation technique and report on the first clinical results. This prospective study covers the first 45 patients to undergo this new technique since it was introduced in 1999. In all patients the operation was successfully performed in a completely minimally invasive procedure. Mono- and bisegmental stabilization was performed mainly at the thoracolumbar junction after initial posterior instrumentation in most cases. Lesions varied from fresh/old fractures to metastases (T5–L3). Pre- and postoperative follow-up included clinical examination and radiological visualization via X-ray and computed tomographic scan. Our experience with this minimally invasive procedure demonstrated the feasibility of the method.     

Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated?

Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently spontaneous, required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in spontaneous SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.     

球囊扩张椎体成形术联合降钙素治疗老年骨质疏松性椎体骨折的疗效

目的回顾性分析球囊扩张椎体后凸成形术联合降钙素治疗骨质疏松性椎体骨折的疗效。方法 2007年2月～2010年1月,对25例35个椎体发生骨质疏松性椎体骨折患者行球囊扩张椎体后凸成形术联合降钙素综合治疗。术中在透视机监视下采用单侧椎弓根穿刺,置入1枚可扩张球囊使骨折塌陷椎体复位,灌注骨水泥充填由球囊扩张所形成的椎体内空腔。术后每天静脉注射鲑鱼降钙素,通过观察患者术后症状改善及骨折复位情况来评估其疗效。结果所有患者随访6～32个月,平均（21.3±0.2）个月。全部患者均顺利完成手术,无症状性并发症发生。术后疼痛明显减轻或消失。术后椎体高度平均恢复率59.5%。结论球囊扩张椎体后凸成形术治疗骨质疏松性椎体骨折可有效缓解疼痛、改善功能及恢复脊柱序列,联合降钙素的应用能有效缓解骨质疏松性椎体压缩骨折引起的疼痛,是治疗骨质疏松性椎体骨折的较好微创方法之一。     

经皮椎体成形术治疗症状性脊椎血管瘤

目的 探讨经皮椎体成形术(percutanous vertebroplasty，PVP)治疗症状性脊椎血管瘤的临床效果。方法 共11例患者，男2例，女9例；年龄35-77岁，平均54.3岁；均有背部疼痛等症状,其中2例有神经根刺激症状；病变部位：胸椎11处，腰椎3处；在DSA或CT监测下对16个稚体(包括2处骨质疏松压缩骨折)行PVP。术后行CT检查。随访3-34个月（平均15.2个月)。结果 11例PVP后均未出现肺栓塞、神经损伤等并发症，术后CT检查示均无推管内或椎间孔渗漏。仅2例2椎存在椎旁少量渗漏，1椎系穿刺针穿破椎体前缘所致，1椎系沿稚旁静脉充盈所致，均未引起临床症状。术后患者背部疼痛均明显减轻或消失，神经根刺激症状消失。首例患者术后疼痛-过性加重，3d内好转、疼痛减轻，考虑与局部炎症有关。术后住院1-4d(平均15d)。随访时症状缓解或消失，与术后相比无明显变化。结论 PVP为症状性脊椎血管瘤提供了一种较好的微创治疗方法。     

350例脊髓血管畸形介入治疗的护理分析

目的探讨护理工作在脊髓血管畸形介入治疗中的价值。方法通过对我院介入中心350例脊髓血管畸形患者介入治疗,针对脊髓血管畸形患者的临床特点和介入治疗方法的适应证、操作过程和预后等特点,从护理学的角度对术前、术中、术后等阶段进行讨论分析。结果术前进行有效的心理护理和健康教育;术中与介入医生及技术操作人员进行有机的配合、熟练使用输液微量泵、准确使用相关药物及认真观察病情变化;术后对患者进行严密的护理观察,可减少并发症的发生,将有助于该手术的成功。结论介入护理工作对脊髓血管畸形介入治疗手术的成败起着至关重要的作用。     

Changes in serum sodium concentration after transurethral procedures

The aim of this study is to evaluate the changes in serum sodium concentration and the degree of correlation with factors such as the amount of intravenous fluid intake, the kind and the amount of irrigating fluids and the duration of the procedure. In this framework, 98 male patients who underwent transurethral procedure were studied and the correlation between the magnitude of hyponatraemia and the above-mentioned parameters was evaluated. All procedures were performed under spinal anesthesia and a solution of either manitol–sorbitol or sterilized water was used as irrigation fluid. Serum sodium concentration was measured before and after the procedure, while the kind and amount of the irrigating fluids, the amount of fluid intake and the duration of the procedure were also recorded. The patients were divided into three groups according to the duration of the procedure (i) <30 min, (ii) 30–60 min, and (iii) >60 min. Significant reduction in serum sodium concentration was found postoperatively (P < 0.001) and this was more profound in procedures longer than 1 h. This reduction was strongly correlated only with the duration of the transurethral procedure (P < 0.01). In conclusion, in transurethral procedures the reduction in serum sodium is postoperatively related to the duration of the procedure, while the intravenous and irrigating fluids to play no role on it.     

An unconventional indication for open kyphoplasty

BACKGROUND CONTEXT: Kyphoplasty is a means of treatment for painful osteoporotic vertebral body compression fractures. Its efficacy has not yet been totally proven. Even though the conventional percutaneous kyphoplasty is a relatively safe procedure, it is not routinely recommended for use in vertebral body fractures that involve posterior cortical compromise/retropulsion or in fractures associated with neurological deficit. PURPOSE: To see whether the open kyphoplasty procedure can be used in patients with painful vertebral body compression fractures who also have bony retropulsion into the spinal canal. STUDY DESIGN/SETTING: This technical report is based on the experience of one patient. METHODS: A 79-year-old woman with a history of osteoporosis presented with a painful vertebral body compression fracture at T12. Magnetic resonance imaging of her lumbar spine demonstrated an acute compression fracture at T12 with significant decrease in vertebral body height and retropulsion of bone resulting in one-third reduction in canal width. She was not considered a candidate for percutaneous kyphoplasty. Three months after the injury, an open kyphoplasty was performed after a decompression laminectomy at T12. RESULTS: The fractured vertebral body was successfully reduced, and there was no leakage of polymethylmethacrylate into the spinal canal through the fractured posterior cortex using the open kyphoplasty procedure. One month after the operation, the patient was free from mid-back pain and was again able to walk. CONCLUSION: Open kyphoplasty procedure allows direct visualization to the spinal canal. It can be performed safely and effectively in selected vertebral body compression fractures with retropulsed bone associated with neurological deficit.     

Course and prognosis of spinal epidural abscess. Report of five cases

Five patients suffering from spinal epidural abscess associated with neurologic deficit are reported. Four patients underwent a decompressive procedure for abscess drainage, and one patient was medically treated. One of the patients showed a neurologic deterioration at the early postoperative period. The long-term follow-up showed a good outcome in all patients. It is concluded that epidural abscess associated with progressive neurologic deficit requires immediate decompression and administration of antibiotic. Postoperative neurological deterioration may be seen despite proper and immediate decompression and in such a case neurologic improvement is observed in the late postoperative period.     

Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases

A retrospective follow-up study of patients who, having undergone instrumented posterior spinal fusion for scoliosis, experienced late infection and then underwent either implant removal alone or implant removal and instrumented refusion. We conducted this study to determine whether it is possible to avoid loss of correction by a single-stage implant removal and reinstrumentation procedure. There have been a few reports of late-appearing infections after spinal instrumentation. Implant bulk, metallurgic reactions, and contamination with low-virulence microorganisms have been suggested as possible etiologic factors. The clinical symptoms include pain, swelling, redness, and spontaneous drainage of fluid. Complete instrumentation removal and systemic antibiotics is usually curative. We retrospectively reviewed 45 patients who underwent instrumented posterior spinal fusion for scoliosis and experienced development of late infections and, after a mean of 3 years after the initial procedure, either underwent implant removal alone [n=35, instrumentation removal (HR) group] or additionally underwent reinstrumentation and fusion [n=10, reinstrumentation and fusion (RI&F) group]. Three patients were reinstrumented 1.5 years after instrumentation removal, and seven underwent a one-stage rod removal and reinstrumentation/refusion procedure. Allergic predisposition, protracted postoperative fever, and pseudarthrosis appear to increase the risk of late-developing infection after posterior spinal fusion. All wounds in both groups healed uneventfully. Preoperative radiographic Cobb measurements showed no statistically significant between-group differences. At follow-up, however, outcome was clearly better in the RI&F group: Loss of correction was significantly smaller in reinstrumented patients. Thus, the thoracic Cobb angle was 28±16° (range 0–55°) in the RI&F group versus 42±15° (21–80°) in the HR group, and the lumbar Cobb angle was 22±11° (10–36°) in the RI&F group versus 29±12° (13–54°) in the HR group. The results of our study demonstrate that wound healing is usually uneventful after instrumentation removal for late infection, also when patients undergo instrumented refusion in a one-stage procedure. Reinstrumentation appears to achieve permanent correction of scoliosis.     

颈椎椎板切除术后神经根病

目的　报道一组多节段颈椎椎板切除术后神经根病并探讨其机理。　方法　２８７ 例颈椎椎板切除术患者中３７ 例（１２．９％ ） 出现手术后神经根病。其中男２７ 例,女１０ 例,平均年龄５６ 岁。其中颈椎病２５ 例, 后纵韧带骨化１２ 例。发病时间为手术后４ 小时～６ 天,最常见类型为颈５（Ｃ５） 、颈６（Ｃ６） 神经根,以运动障碍为主。　结果　完全缓解时间平均为５ ．４ 个月（２ 周～３ 年）。完全缓解时间与脊髓运动功能恢复率呈负相关（ｒ＝ －０ ．８３２, Ｐ＜ ０．０１）,颈椎病患者预后优于后纵韧带骨化（ｔ＝２ ．９６０, Ｐ＜ ０．０１）。　结论　手术后神经根病可能因颈椎后路减压后神经根栓系引起;前路减压及融合手术既可直接切除致压物,又能稳定脊柱,因而可有效预防手术后神经根病     

Graf ligament stabilisation: mid- to long-term follow-up

Previous studies have looked at early follow-up of the Graf ligament stabilisation system. We present mid- to long-term results of this procedure. A retrospective review of Graf ligaments inserted since 1993 was undertaken. A total of 51 patients were reviewed. Pre-operative Oswestry Disability Index scores were compared to post-operative scores recorded via a postal questionnaire. There were 28 men and 23 women. The average age was 41 years (range, 2267 years). The mean pre-operative score was 46 (range, 22-78), the mean follow-up time was 51 months (range, 23-84 months) and the mean post-operative score was 40 (range, 0-82). There were 12 complications (4 requiring further surgery), and seven patients went on to require bony fusion procedures. Forty one per cent of the group would choose not to have the operation again. Longer-term results of this technique are not as encouraging as earlier studies. The continued use of this procedure should be viewed with caution.     

One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis

There are few articles in the literature concerning anterior instrumentation in the surgical management of spinal tuberculosis in the exudative stage. So we report here 23 cases of active thoracolumbar spinal tuberculosis treated by one-stage anterior interbody autografting and instrumentation to verify the importance of early reconstruction of spinal stability and to evaluate the results of one-stage interbody autografting and anterior instrumentation in the surgical management of the exudative stage of throracolumbar spinal tuberculosis. Twenty-three patients, including two children (9 and 15 years old, respectively) and 21 adults with thoracolumbar spinal tuberculosis were treated surgically. T9 to L4 spinal segments were affected, and MRI/CT showed evident collapse of the vertebrae because of tuberculous destruction and paravertebral abscess. Neurological deficits were found in 15 patients. Before surgery, patients received standard anti-tuberculosis chemotherapy for 2 to 3 weeks. Under general endotracheal anaesthesia, the patients were placed in right recumbent positions, and a transthoracic, lateral extracavitary or extrapleural approach was chosen according to the tuberculosis lesion segment. After exposure, the tuberculous lesion region, including the collapsed vertebrae and in-between intervertebral disc, was almost completely resected in order to release the segmental spinal cord. Then, autologous iliac, rib or fibular graft was harvested to complete interbody fusion, and an anterior titanium-alloy plate-screw system was used to reconstruct the stability of the affected segments. Anti-tuberculosis chemotherapy was continued for at least 9 months, and the patients were supported with thoracolumbosacral orthosis for 6 months after surgery. All patients were followed up for an average of 2 years. All 23 cases were healed without chronic sinus formation or any recurrence of tuberculosis during the follow-up period. Spinal fusion occurred at a mean of 3.8 months after surgery. Of all patients with neurological deficits, 14 patients showed obvious improvement; only one patient with Frankel C lesion remained unchanged, but none of the patients got worse. During the follow-up period, a mean of 18 degrees of kyphosis correction was achieved after surgery in the adult group. Moderate progressive kyphosis because of this procedure fusion occurred postoperatively in a 9-year-old child after 2 1/2 years; another 15-year-old child did not demonstrate this phenomenon. Except for the early loosening of one screw in two cases (which did not affect the reconstruction of spinal stability), no other complications associated with this procedure were found during follow-up. Early reconstruction of spinal stability plays an important role in the surgical management of spinal tuberculosis. One-stage anterior interbody autografting and instrumentation in the surgical management of the exudative stage of spinal tuberculosis show more advantages in selected patients, but supplementary posterior fusion should be considered to prevent postoperative kyphosis when this procedure is performed in children.This article was presented at the Conference of Eurospine 2001, Gothenburg, Sweden.     

Acute non-traumatic extensive subdural spinal hematoma

Acute spinal subdural hematoma is a somewhat rare pathology. Its severity comes from the constitution of an acute spinal cord compression. In many cases MRI is useful for the differential diagnosis with the epidural hematoma. A 79-year-old patient was referred for emergency neurosurgery for acute spinal cord compression. The vascular risk in this patient was significant: hypertension, oral anticoagulants. Clinically, acute non-traumatic subdural spinal hematoma was suspected. The spinal cord MRI was in favor of the diagnosis which was confirmed intraoperatively. The surgical procedure revealed an extensive hematoma which infiltrated the spinal cord. The diagnosis of nontraumatic subdural spinal hematoma may be difficult in some cases and correctly established only during the surgical procedure. In comparison with reports in the literature, we discuss the underlying mechanisms of this hematoma. Spinal subdural haematoma must be considered in patients taking anticoagulant therapy or with a coagulation disorder who present signs of acute spinal cord compression. MRI sagittal T1 and T2-weighted images are adequate and reliable for diagnosis of spinal subdural hematoma. Prompt surgical evacuation of this hematoma is crucial.     

脊髓圆锥部选择性脊神经前、后根切断术治疗痉挛性脑瘫

探讨脊髓圆锥部选择性脊神经前,后根切断术治疗痉挛性脑瘫的疗效。方法１９９４－１９９８年在脊髓圆锥部进行选择性脊神经后根切断术的同时进行选择脊神经切断术治疗痉挛性脑瘫２８例。并选１０例双下肢痉挛性脑瘫患者作同体两侧肢体不同方法治疗对照,右侧行ＳＰＲ＋ＳＡＲ手术,左侧仅行ＳＰＲ手术。结果脊髓圆锥部手术较腰骶部传统术式具有切口小,创伤小,出血少,操作简捷,手术时间短和并发症少等优点。按刘小林疗效评价标准     

单球囊单侧穿刺经皮椎体后凸成形术治疗多椎体骨质疏松性压缩性骨折

目的探讨Ⅰ期应用单个球囊单侧穿刺多次扩张经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗多椎体骨质疏松性脊柱压缩性骨折的临床疗效。方法采用单球囊单侧穿刺PKP治疗骨质疏松性脊柱压缩性骨折25例共60个椎体。术后观察疼痛缓解及骨折复位情况,比较手术前后椎体高度和后凸角(Cobb角)的变化。结果所有患者均顺利完成手术。手术时间53～146min,平均30.4min/椎。术中球囊扩张压力为98～320Psi,平均183Psi;扩张体积2～4.5ml,平均3.25ml;扩张次数2～6次,平均3.3次,3例球囊术中破裂。骨水泥注射量2～5ml,平均3.5ml/椎,2例椎管内出现少量渗漏,1例发生椎旁渗漏,均无明显临床症状。患者VAS由术前的(7.5±1.0)分降低到术后的(3.2±0.7)分,椎体前缘高度、中线高度和Cobb角均较术前有明显改善,差异具有统计学意义(P0.05)。术后随访6～24个月,受访患者疼痛症状得到明显缓解,未见神经损伤等并发症发生。结论单侧穿刺单个球囊多次扩张PKP具有手术时间短、治疗费用低、疗效满意等优点,可用于治疗多发性骨质疏松性脊柱压缩性骨折。     

Extended costotransversectomy to achieve circumferential fusion for pathologies causing thoracic instability

Background contextConventional circumferential stabilization for pathologies causing instability of the thoracic spine requires a two or even a three-staged procedure. The authors present their tertiary care center experience of single-staged procedure to establish a circumferential fusion through an extended costotransversectomy approach.ObjectiveTo demonstrate neural canal decompression, removal of the pathology, achieve circumferential fusion, and correcting the deformity through a single procedure.Study designProspective and observational.Patient sampleForty-six patients with pan thoracic column instability due to various pathologies.Outcome measuresNeurologic condition was evaluated using American Spinal Injury Association and Eastern Cooperative Oncology Group grading systems. Outcome was evaluated with regard to the decompression of neural canal, correction of deformity, and neurologic improvement. All patients were evaluated for neural canal compromise and degree of kyphosis preoperatively, early, and late postoperatively.MethodsAll patients had severe spinal canal compromise (mean, 59%±9%) and loss of vertebral body height (mean, 55%±10%). A single-stage circumferential fusion was performed (four-level pedicle screw fixation along with a ventral cage fixation after a vertebrectomy or corpectomy) through an extended costotransversectomy approach.ResultsThe pathologies included trauma (21), tuberculosis (18), hemangioma (2), aneurysmal bone cyst (1), recurrent hemangioendothelioma (1), solitary metastasis (1) and plasmacytoma (1), and neurofibromatosis (1). Thirty-five of 46 patients (76%) demonstrated improvement in the performance status. The major complications included pneumonitis (3), pneumothorax (3) and neurologic deterioration (3; improved in two), deep venous thrombosis (2), and recurrent hemoptysis (1). No implant failures were noted on last radiology follow-up. There were two mortalities; one because of myocardial infarction and another because of respiratory complications.ConclusionsThe following study demonstrated that extended costotrasversectomy approach is a good option for achieving single-staged circumferential fusion for correcting unstable thoracic spine due to both traumatic and nontraumatic pathologies.     

A radical procedure of circumferential spinal cord decompression through a modified posterior approach for thoracic myelopathy caused by severely impinging anterior ossification

Background contextThoracic myelopathy caused by an anterior, massive ossified plaque is often progressive and responds poorly to conservative treatment. Direct removal of the compressing ossification is the optimal procedure for a spinal cord that is severely impinged anteriorly. However, both anterior and posterior decompressive manipulations have caused catastrophic iatrogenic spinal cord injuries. A comprehensive treatment method for severe thoracic myelopathy that enables a sufficient and safe decompression of the spinal cord is needed.PurposeThe purpose of this study is to demonstrate the efficacy, safety, and results of a one-stage circumferential decompressive procedure using a modified posterior approach in patients with severe thoracic myelopathy resulting from anterior spinal compression.Study designA modified procedure of circumferential spinal cord decompression for thoracic myelopathy is described. A retrospective study was conducted to investigate the clinical outcomes of 23 sequentially treated patients.Patient sampleTwenty-three patients were treated sequentially with a modified procedure for circumferential spinal cord decompression for thoracic myelopathy.Outcome measuresOutcomes were assessed using the Japanese Orthopedic Association (JOA) score, modified Frankel classification, Hirabayashi recovery rate, and a general assessment of complications.MethodsTwenty-three patients with thoracic myelopathy caused by a massive, anterior ossified structure were treated with an extensive posterior laminectomy, anterior removal of the ossification, and interbody fusion with kyphosis-reversing stabilization through a modified posterolateral approach. The neurologic outcomes are evaluated according to the JOA and the modified Frankel classification before surgery, 2 weeks after surgery, 1 year after surgery, and at the final follow-up visit. The surgical outcomes are also described using the Hirabayashi recovery rate. Radiographs, computed tomography (CT), and magnetic resonance imaging were performed before and after surgery. A postoperative CT scan was obtained to determine the efficacy of the decompression. Operative time, intraoperative blood loss, and complications were reviewed from the medical records. In addition, a 48-year-old man who presented with severe thoracic myelopathy resulting from anterior impingement with multiple osteophytes is described as an illustrative patient.ResultsThe sites of ossification in this series were distributed widely, from T4–T12. The anterior ossified plaques of all patients were resected completely. Five patients who had intraoperative evidence of dural ossification required resection of the ossified dura matter. The average operating time was 276 minutes. Mean intraoperative blood loss was 1,350 mL. The postoperative follow-up ranged from 2.5 to 6 years, with an average of 4.6 years. The average preoperative JOA score was 4.3±1.5 points, and it improved to 6.1±1.9 points 2 weeks postoperatively, to 8.1±1.8 points 1 year postoperatively, and to 8.5±1.9 points at the most recent follow-up. The overall Hirabayashi recovery rate at the final examination averaged 63.6±22.4%. Eight patients were graded as excellent, 10 as good, 4 as fair, and 1 as unchanged. No patient was graded as deteriorated. The paralysis improved by at least 1 grade in 22 patients (95.7%). Transient deterioration of thoracic myelopathy occurred immediately after surgery in three patients (13%). Cerebrospinal fluid leakage occurred in six patients (26.1%). One patient sustained severe bilateral groin pain, three had unilateral intercostal neuralgia, and pleura tear occurred in one patient.ConclusionOne-stage posterior decompression, anterior extirpation of the ossification, and interbody fusion with instrumentation via a modified posterior approach is a safe and effective treatment for severe thoracic myelopathy resulting from prominent anterior impingement. This procedure is technically demanding, and the indications are limited to thoracic myelopathy caused by severe anterior impingement of various etiologies from T4–T12.