Skip to main content

Advertisement

SpringerLink
Log in

Surgery of degenerative thoracic spinal stenosis—long-term outcome with quality-of-life after posterior decompression via an uni- or bilateral approach

  • Original Article - Spine degenerative
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The rate of degenerative thoracic spinal stenosis (TSS) as underlying pathology for myelopathy is not precisely known, and larger case series are only available for the Asian region. We present one of the largest European series to evaluate rate and clinical outcome after dorsal decompression via a uni- or bilateral approach.

Method

We investigated patients’ characteristics, imaging/surgical parameters, and outcomes with quality-of-life (QOL) in all patients who underwent surgical treatment for TSS between 2013 and 2018 in a university neurosurgical clinic.

Results

From 645 patients with surgery for degenerative spondylotic myelopathy within 6 years, 28 patients (4.3%) suffered from TSS. Median age was 70.4 years with a slight predominance of the female sex (m:f = 1:1.3). The most frequent symptoms (mean duration 7.6 months) were ataxia (61%) and sensory changes (50%). The stenoses (median Naganawa score 3) mostly resulted from a combined osseous/ligamentous hypertrophy and disc prolapse, the majority located below Th8 (75%). Nineteen patients with lateralized compression underwent bilateral decompression via a unilateral approach (fenestration/hemilaminectomy with “undercutting” procedure), and 9 patients with circular pathology underwent bilateral-approached decompression (laminectomy). There were no significant differences of patients’ characteristics, blood loss, operation time, and in-patient stay between both surgical groups. Independent from the mode of surgery, the spinal canal was significantly (p < 0.001) widened (median Naganawa score 0), and pain (p = 0.04), myelopathy (mJOA score p = 0.01), and QOL (Oswestry Disability Index, p = 0.03; SF-36-MCS, p = 0.01) were significantly improved at long-term follow-up (mean 35.1 months).

Conclusions

Non-tumorous myelopathy is caused in about 4% of patients by TSS and can be effectively treated by surgical decompression via both a uni- or bilateral approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AP:

Anteroposterior

BI:

Barthel Index

C:

Cervical

CSS:

Cervical spinal stenosis

CSF:

Cerebrospinal fluid

CT:

Computed tomography

HR:

Hazard ratio

i.e.:

Id est

ISI:

Increased signal-intensity

MCID:

Minimum clinically important difference

MCS:

Mental component summary

min.:

Minutes

mJOA score:

Modified Japanese Orthopedic Association score (by Benzel)

ml:

Milliliter

MRI:

Magnetic resonance imaging

no.:

Number

ODI:

Oswestry Disability Index

OLF:

Ossification of the ligamentum flavum

OPLL:

Ossification of the posterior longitudinal ligament

PCS:

Physical component summary

PROM:

Patient-reported outcome measure

QOL:

Quality-of-life

SEM:

standard error of measurement

SF-36:

Short Form-36v2® Health Survey

Th:

Thoracic

TSS:

Thoracic spinal stenosis

VAS:

Visual analogue scale

yrs.:

Years

References

  1. Aizawa T, Sato T, Sasaki H, Matsumoto F, Morozumi N, Kusakabe T, Itoi E, Kokubun S (2007) Results of surgical treatment for thoracic myelopathy. Minimum 2-year follow-up study in 132 patients. J Neurosurg Spine 7(1):13–20

    Article  Google Scholar 

  2. Ashana AO, Ajiboye RM, Sheppard WL, Sharma A, Kay AB, Holly LT (2017) Cervical paraspinal muscle atrophy rates following laminoplasty and laminectomy with fusion for cervical spondylotic myelopathy. World Neurosurg 107:445–450

    Article  Google Scholar 

  3. Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 4(3):286–295

    Article  CAS  Google Scholar 

  4. Bu G, Shuang F, Liu G, Wu Y, Hou S, Ren D, Shang W (2016) Efficacy and safety of one-stage selective discectomy combined with expansive hemilaminectomy in the treatment of cervical spondylotic myelopathy. World Neurosurg 94:507–512

    Article  Google Scholar 

  5. Chang UK, Choe WJ, Chung CK, Kim HJ (2001) Surgical treatment for thoracic spinal stenosis. Spinal Cord 39(7):362–369

    Article  CAS  Google Scholar 

  6. Draak THP, de Greef BTA, Faber CG, Merkies ISJ (2019) The minimum clinically important difference. Which direction to take. Eur J Neurol 26(6):850–855

    Article  CAS  Google Scholar 

  7. Dützmann S, Fernandez R, Rosenthal D (2019) Spinalkanalstenose im Thorakalbereich. Ätiologie, Pathogenese, Diagnostik und Therapie (thoracic spinal stenosis: etiology, pathogenesis, and treatment). Orthopade 48(10):844–848. https://doi.org/10.1007/s00132-019-03731-8

    Article  PubMed  Google Scholar 

  8. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66(8):271–273

    CAS  PubMed  Google Scholar 

  9. Fujimura Y, Nishi Y, Nakamura M, Toyama Y, Suzuki N (1997) Long-term follow-up study of anterior decompression and fusion for thoracic myelopathy resulting from ossification of the posterior longitudinal ligament. Spine 22(3):305–311

    Article  CAS  Google Scholar 

  10. Ghogawala Z, Martin B, Benzel EC, Dziura J, Magge SN, Abbed KM, Bisson EF, Shahid J, Coumans J-VCE, Choudhri TF, Steinmetz MP, Krishnaney AA, King JT, Butler WE, Barker FG, Heary RF (2011) Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy. Neurosurgery 68(3):622–630 discussion 630-1

    Article  Google Scholar 

  11. He B, Yan L, Xu Z, Guo H, Liu T, Hao D (2014) Treatment strategies for the surgical complications of thoracic spinal stenosis. A retrospective analysis of two hundred and eighty three cases. Int Orthop 38(1):117–122

    Article  Google Scholar 

  12. Hou X, Sun C, Liu X, Liu Z, Qi Q, Guo Z, Li W, Zeng Y, Chen Z (2016) Clinical features of thoracic spinal stenosis-associated myelopathy. A retrospective analysis of 427 cases. Clin Spine Surg 29(2):86–89

    Article  Google Scholar 

  13. Karademir M, Kucuk A, Ulutabanca H, Selcuklu A, Menku A, Tucer B (2017) The comparison of hemilaminectomy and laminoplasty procedures in the surgical treatment of cervical spondylotic myelopathy. Turk Neurosurg 27(1):74–84

    PubMed  Google Scholar 

  14. MAHONEY FI, BARTHEL DW (1965) Functional evaluation. The Barthel Index. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  15. Mielke D, Rohde V (2015) Bilateral spinal canal decompression via hemilaminectomy in cervical spondylotic myelopathy. Acta Neurochir 157(10):1813–1817

    Article  Google Scholar 

  16. Naganawa T, Miyamoto K, Ogura H, Suzuki N, Shimizu K (2011) Comparison of magnetic resonance imaging and computed tomogram-myelography for evaluation of cross sections of cervical spinal morphology. Spine 36(1):50–56

    Article  Google Scholar 

  17. Onishi E, Yasuda T, Yamamoto H, Iwaki K, Ota S (2016) Outcomes of surgical treatment for thoracic myelopathy. A single-institutional study of 73 patients. Spine 41(22):E1356–E1363

    Article  Google Scholar 

  18. Ren D-J, Li F, Zhang Z-C, Kai G, Shan J-L, Zhao G-M, Sun T-S (2015) Comparison of functional and radiological outcomes between two posterior approaches in the treatment of multilevel cervical spondylotic myelopathy. Chin Med J 128(15):2054–2058

    Article  Google Scholar 

  19. Shiokawa K, Hanakita J, Suwa H, Saiki M, Oda M, Kajiwara M (2001) Clinical analysis and prognostic study of ossified ligamentum flavum of the thoracic spine. J Neurosurg 94(2 Suppl):221–226

    CAS  PubMed  Google Scholar 

  20. Sihvonen T, Herno A, Paljärvi L, Airaksinen O, Partanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18(5):575–581

    Article  CAS  Google Scholar 

  21. Tetreault L, Nouri A, Kopjar B, Côté P, Fehlings MG (2015) The minimum clinically important difference of the modified Japanese Orthopaedic Association scale in patients with degenerative cervical myelopathy. Spine 40(21):1653–1659

    Article  Google Scholar 

  22. Ware J, Kosinski M, Bjorner J, Turner-Bowker D, Gandek B, Maruish M (2007) Development. User’s manual for the SF-36v2® Health Survey. Lincoln (RI): QualityMetric incorporated

  23. Yamazaki M, Mochizuki M, Ikeda Y, Sodeyama T, Okawa A, Koda M, Moriya H (2006) Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament. Operative indication of posterior decompression with instrumented fusion. Spine 31(13):1452–1460

    Article  Google Scholar 

  24. Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K (2007) MR T2 image classification in cervical compression myelopathy. Predictor of surgical outcomes. Spine 32(15):1675–1678 discussion 1679

    Article  Google Scholar 

  25. Zhang H-Q, Chen L-Q, Liu S-H, Zhao D, Guo C-F (2010) Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level. J Neurosurg Spine 13(1):116–122

    Article  Google Scholar 

Download references

Acknowledgments

We are grateful to all patients participating in our study.

Author information

Authors and Affiliations

  1. Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany

    Sebastian Siller, Laura Pannenbaecker, Joerg-Christian Tonn & Stefan Zausinger

Authors
  1. Sebastian Siller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Pannenbaecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joerg-Christian Tonn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Zausinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sebastian Siller.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local Institutional Review Board of the Ludwig-Maximilians-University Munich and agrees with all standards regarding the use of informed consent according to the guidelines of the local Institutional Review Board of the Ludwig-Maximilians-University Munich (Project # 18-259).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Spine degenerative

Presentation at a conference

Parts of this paper have been presented orally at the Annual Spine Section Meeting of the German Society of Neurosurgery held in Giessen (Germany) on September 07, 2019, and at the 14th Annual Meeting of the German Spine Society held in Munich (Germany) on November 28, 2019.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Siller, S., Pannenbaecker, L., Tonn, JC. et al. Surgery of degenerative thoracic spinal stenosis—long-term outcome with quality-of-life after posterior decompression via an uni- or bilateral approach. Acta Neurochir 162, 317–325 (2020). https://doi.org/10.1007/s00701-019-04191-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-019-04191-x

Keywords

Search

Navigation