前路内固定矫正结核性脊柱畸形

目的　总结前路病灶清除、椎体间植骨和前路内固定手术治疗结核性脊柱畸形的临床疗效 ,探讨前路内固定植入在脊柱结核外科治疗中的安全性和价值。　方法　 1997年 6月～ 2 0 0 1年5月 ,采用前路病灶清除、椎体间植骨和一期前路内固定手术治疗脊柱结核 18例 ,其中颈椎 1例 ,胸椎10例 ,胸腰段 2例 ,腰椎 5例。平均每例受累椎体 2 8个。脊柱后凸畸形角度 2 7 0°～ 75 5°,平均47 5°± 11 4°。均采用髂骨植骨。　结果　 18例病例均获得随访 ,平均随访时间 2 5个月。所有病例均未出现伤口深部感染或窦道形成 ,植骨均完全融合 ,平均融合时间为 3 6个月。后凸畸形矫正度数为 32 7°± 8 3°,后期矫正度丢失 3 2°± 2 8°。　结论　前路内固定手术在脊柱外科治疗中能有效地达到矫正后凸畸形、重建脊柱稳定性和促进椎体间植骨融合的目的 ,是一种安全和有效的治疗方法。     

The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading

To better understand the biomechanical mechanisms underlying the association between hyperkyphosis of the thoracic spine and risk of vertebral fracture and other degenerative spinal pathology, we used a previously validated musculoskeletal model of the spine to determine how thoracic kyphosis angle and spinal posture affect vertebral compressive loading. We simulated an age‐related increase in thoracic kyphosis (T₁–T₁₂ Cobb angle 50–75 degrees) during two different activities (relaxed standing and standing with 5‐kg weights in the hands) and three different posture conditions: (1) an increase in thoracic kyphosis with no postural adjustment (uncompensated posture); (2) an increase in thoracic kyphosis with a concomitant increase in pelvic tilt that maintains a stable center of mass and horizontal eye gaze (compensated posture); and (3) an increase in thoracic kyphosis with a concomitant increase in lumbar lordosis that also maintains a stable center of mass and horizontal eye gaze (congruent posture). For all posture conditions, compressive loading increased with increasing thoracic kyphosis, with loading increasing more in the thoracolumbar and lumbar regions than in the mid‐thoracic region. Loading increased the most for the uncompensated posture, followed by the compensated posture, with the congruent posture almost completely mitigating any increases in loading with increased thoracic kyphosis. These findings indicate that both thoracic kyphosis and spinal posture influence vertebral loading during daily activities, implying that thoracic kyphosis measurements alone are not sufficient to characterize the impact of spinal curvature on vertebral loading. © 2012 American Society for Bone and Mineral Research.     

Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study.

It is unknown whether kyphosis of the thoracic spine is an independent risk factor for future osteoporotic fractures. In 596 community-dwelling women, we found that with increasing kyphosis, there was a significant trend of increasing fracture risk that was independent of previous history of fractures or BMD. INTRODUCTION: It is unknown whether kyphosis of the thoracic spine is an independent risk factor for future osteoporotic fractures. MATERIALS AND METHODS: We conducted a prospective cohort study of 596 community-dwelling women, 47-92 years of age. Between 1988 and 1991, BMD of the hip and spine and kyphosis were measured. Kyphosis was measured by counting the number of 1.7-cm blocks necessary to place under the occiput so participants could lie flat without neck hyperextension. New fractures were reported over an average follow-up of 4 years. RESULTS: Using a cut-off of at least one block, 18% of the participants had hyperkyphotic posture (range, one to nine blocks). There were 107 women who reported at least one new fracture (hip, spine, wrist, clavicle, shoulder, arm, hand, rib, pelvis, leg, or ankle). In logistic regression analyses, older women with hyperkyphotic posture (defined as at least one block) had a 1.7-fold increased risk of having a future fracture independent of age, prior fracture, and spine or hip BMD (95% CI: 1.00-2.97; p = 0.049). There was a significant trend of increasing fracture risk with increasing number of blocks, with ORs ranging from 1.5 to 2.6 as the number of blocks increased from one to at least three blocks compared with those with zero blocks (trend p = 0.03; models adjusted for age, baseline fracture, spine or hip BMD). Stratification by baseline fracture status and controlling for other possible confounders or past year falls did not change the results. CONCLUSIONS: Whereas hyperkyphosis may often result from vertebral fractures, our study findings suggest that hyperkyphotic posture itself may be an important risk factor for future fractures, independent of low BMD or fracture history.     

个体化导航模板在胸椎椎弓根螺钉置入中的初步临床应用

目的:通过临床应用评价个体化导航模板辅助胸椎椎弓根螺钉置入的准确性和安全性。方法:2008年7月～2009年9月,对11例需要行胸椎椎弓根螺钉置入手术的患者(青少年特发性脊柱侧凸7例,先天性脊柱侧凸2例,胸椎结核后凸畸形1例,多发性胸椎骨折1例)术前根据CT三维重建图像利用计算机辅助设计及快速成型技术设计制作46个胸椎个体化导航模板,术中应用个体化导航模板辅助在T2～T12置入椎弓根螺钉92枚,术后CT扫描评价螺钉位置,记录有无与螺钉置入相关的并发症。结果:通过个体化导航模板辅助置入的92枚胸椎椎弓根螺钉中,83枚完全在椎弓根内,9枚穿破椎弓根壁(其中椎弓根内侧壁穿破2枚、椎弓根外侧壁穿破7枚),其中5枚螺钉因椎弓根宽度小于4mm(3.0～3.8mm)而采用椎弓根旁固定方法(椎弓根螺钉轻度穿破椎弓根外侧壁经胸肋关节内侧进入椎体),椎弓根壁非故意穿破率为4.3%,置钉准确率为95.7%,所有穿破椎弓根壁的螺钉的穿出距离均小于2mm,螺钉位置可接受率为100%。无与螺钉置入有关的神经、血管、内脏损伤等并发症的发生。结论:个体化导航模板辅助胸椎椎弓根螺钉置入的置钉准确率高,安全、可行。     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

Wrist fracture, heel bone density and thoracic kyphosis: a case control study

The heel bone density measured by Broadband Ultrasound Attenuation (BUA), the thoracic kyphosis measured by a Kyphometer, height, and weight were compared between 294 women over 49 years of age who sustained a wrist fracture and 294 age-matched women who had not previous wrist, hip or spine fracture. The BUA was significantly less in the women who had wrist fracture (p less than 0.0005), though there was a considerable overlap between the two populations. The women with wrist fracture had significantly greater thoracic kyphosis (p less than 0.0005) and smaller stature (p less than 0.0005). There was no significant difference in weight. There was a significant tendency (p less than 0.0005) for women in the fracture patient group to have both poor BUA and greater kyphosis.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.     

一期后路全脊椎切除并内固定矫形治疗胸腰椎疾患

目的 观察一期后路全脊椎切除并内固定矫形治疗胸腰椎疾患的疗效.方法 对17例胸腰椎疾患(6例陈旧性脊柱骨折脱位,4例全脊椎结核,5例脊柱侧后凸畸形,2例全脊椎肿瘤)全脊柱切除的疗效进行回顾性分析.其中14例伴有后凸或侧后凸成角畸形,12例病变节段以下完全或不完全性瘫痪.对所有患者一期经后路行病椎全脊椎切除,环脊髓减压、...     

The successful short-term treatment of flexion-distraction injuries of the thoracic spine using posterior-only pedicle screw instrumentation

STUDY DESIGN: In this retrospective study, the results of treating unstable flexion-distraction injuries (FDI) of the thoracic spine with posterior-only thoracic pedicle screw (P/TPS) instrumentation were investigated. OBJECTIVE: The objective was to determine the ability of P/TPS to correct and maintain the focal kyphosis of the injured spine. Clinical outcome and complications of the surgical procedure were also a focus of the study. SUMMARY OF BACKGROUND DATA: The treatment of FDI of the thoracic spine remains controversial. There continues to be difficulty in maintaining the corrected kyphosis angle regardless of the surgical approach used. METHODS: Eighteen patients with FDI of thoracic spine who underwent P/TPS were identified. The initial and corrected focal kyphosis was evaluated radiographically. Failure of treatment was defined as a >5-degree progression of corrected kyphosis from initial to latest follow-up. Clinical evaluation included complication rate, Injury Severity Score, and Frankel grade. RESULTS: Of the 18 eligible patients, 15 (83%) had adequate follow-up for evaluation. The mean length of follow-up care was 16.1 months. The average Injury Severity Score was 23. The average number of instrumented levels was 6.8. The focal kyphosis of the injury was reduced from a mean of 19.60 to 5.73 degrees (P<0.001), with an average progression of only 2.27 degrees (P=0.128) at final follow-up. Complications were limited to wound infections and occurred in 2 study participants. Neurologic status returned to normal in all patients with incomplete cord injuries. CONCLUSIONS: FDI of the thoracic spine may be amendable to a uniform surgical approach with P/TPS. This procedure carried a relatively low complication rate and allowed for reduction and restoration of the posterior tension band with a biomechanically rigid construct.     

Hyperkyphosis,Kyphosis Progression,and Risk of Non‐Spine Fractures in Older Community Dwelling Women: The Study of Osteoporotic Fractures (SOF)

While accentuated kyphosis is associated with osteoporosis, it is unknown whether it increases risk of future fractures, independent of bone mineral density (BMD) and vertebral fractures. We examined the associations of baseline Cobb angle kyphosis and 15 year change in kyphosis with incident non‐spine fractures using data from the Study of Osteoporotic Fractures. A total of 994 predominantly white women, aged 65 or older, were randomly sampled from 9704 original participants to have repeated Cobb angle measurements of kyphosis measured from lateral spine radiographs at baseline and an average of 15 years later. Non‐spine fractures, confirmed by radiographic report, were assessed every 4 months for up to 21.3 years. Compared with women in the lower three quartiles of kyphosis, women with kyphosis greater than 53° (top quartile) had a 50% increased risk of non‐spine fracture (95% CI, 1.10–2.06 after adjusting for BMD, prevalent vertebral fractures, prior history of fractures, and other fracture risk factors. Cobb angle kyphosis progressed an average of 7° (SD = 6.8) over 15 years. Per 1 SD increase in kyphosis change, there was a multivariable adjusted 28% increased risk of fracture (95% CI, 1.06–1.55) that was attenuated by further adjustment for baseline BMD (HR per SD increase in kyphosis change, 1.19; 95% CI 0.99–1.44). Greater kyphosis is associated with an elevated non‐spine fracture risk independent of traditional fracture risk factors in older women. Furthermore, worsening kyphosis is also associated with increased fracture risk that is partially mediated by low baseline BMD that itself is a risk factor for kyphosis progression. These results suggest that randomized controlled fracture intervention trials should consider implementing kyphosis measures to the following: (1) further study kyphosis and kyphosis change as an additional fracture risk factor; and (2) test whether therapies may improve or delay its progression. © 2014 American Society for Bone and Mineral Research.     

Treatment of myelopathy due to cervicothoracic OPLL via open door laminoplasty

STUDY DESIGN: Postoperative long-term follow-up study of open door laminoplasty for the ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. OBJECTIVES: Techniques and outcomes of open door laminoplasty were described. The efficacy of this procedure was discussed and compared with other surgical methods for thoracic OPLL reported in the literature. SUMMARY OF BACKGROUND DATA: OPLL of the thoracic spine is often associated with cervical OPLL or ossification of the yellow ligament (OYL) of the thoracic spine; therefore, it is extremely difficult to determine the most appropriate surgical therapeutic procedure. There are very few detailed reports about extensive laminoplasty for OPLL of the thoracic spine. METHODS: The subjects included in this study consisted of 13 consecutive patients of thoracic OPLL who were surgically treated between 1994 and 2003 by the open door laminoplasty using the spinal processes and ligament complex as spacers for the open side. The number of manipulated lamina, including the cervical spine, was from 7 to 14 (mean 10 laminae), the follow-up period was 75 months on average. We evaluated the clinical symptoms by the JOA scoring method and postoperative bone union and thoracic kyphosis by plain x-ray photograph and computed tomography. RESULTS: Postoperatively, the JOA score improved from an average of 5.5 to 8.5 out of a maximum of 11 points and the mean recovery rate by Hirabayashi method was 54.5%. In all cases, bone union was seen at the hinge side between the opened lamina and the lateral mass. Neither restenosis of the opened lamina nor marked progression of kyphosis were seen on the final follow-up observation in any patient. There was no postoperative spinal cord injury. CONCLUSIONS: Open door laminoplasty is a useful procedure for OPLL of the thoracic spine. This method enables wide-range posterior decompression, especially for the continuous type OPLL extending from the cervical spine to the thoracic spine, even if the apex of the thoracic kyphosis is included.