Skip to main content
SpringerLink
Log in

“U” route transforaminal percutaneous endoscopic thoracic discectomy as a new treatment for thoracic spinal stenosis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purposes

To describe the rationale, surgical technique, and short-term follow-up results of a new minimally invasive treatment for thoracic spinal stenosis (TSS) caused by herniation, ossification of the ligamentum flavum (OLF), and/or ossification of the posterior longitudinal ligament (OPLL) with a “U” route transforaminal percutaneous endoscopic thoracic discectomy (PETD).

Methods

Fourteen patients, including seven males and seven females, underwent “U” route PETD. Myelopathy was caused by OLF in 14 patients, OPLL in one, combined OLF-OPLL in ten, and intervertebral disc herniation (IDH) in five. Decompression was performed in one segment in 12 patients, and in two segments in two patients. The Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, and complications were documented.

Results

The JOA scores improved from 4.64 ± 2.31 pre-operatively to 7.07 ± 1.59 one day post-operatively and 11.79 ± 1.85 at final follow-up. The difference between pre-operation and post-operation was statistically significant (P < 0.05). Moreover, the VAS score was 6.07 ± 2.06 points pre-operatively, decreasing to 3.00 ± 1.24 points at one day post-operatively, and 1.14 ± 0.86 points at last follow-up (P < 0.05). Dural tear was observed in two cases during the intervention. No patient had transient worsening of pre-operative paralysis.

Conclusions

This retrospective analysis shows that “U” route PETD for decompression may be a feasible alternative to treat thoracic spinal stenosis.

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
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Min JH, Jang JS, Lee SH et al (2008) Clinical results of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine treated by anterior decompression. J Spinal Disord Tech 21:116–119

    Article  PubMed  Google Scholar 

  2. Yamazaki M, Okawa A, Fujiyoshi T (2010) Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament. Eur Spine J19(5):691–698

    Article  Google Scholar 

  3. Li Z, Ren D, Zhao Y, Hou S (2016) Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases. Spinal Cord 54(3):188–196

    Article  CAS  PubMed  Google Scholar 

  4. Takahata M, Ito M, Abumi K et al (2008) Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine 33:1199–1208

    Article  PubMed  Google Scholar 

  5. Guo JJ, Luk KD, Karppinen J et al (2010) Prevalence, distribution, and morphology of ossification of the ligamentum Flavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine 35(1):51–56

  6. Aizawa T, Sato T, Sasaki H et al (2006) Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population. J Neurosurg Spine 5(6):514–519

    Article  PubMed  Google Scholar 

  7. Hanai K, Ogikubo O, Miyashita T et al (2002) Anterior decompression for myelopathy resulting from thoracic ossification of the posterior longitudinal ligament. Spine 27:1070–1076

    Article  PubMed  Google Scholar 

  8. Tomita K, Kawahara N, Baba H et al (1990) Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and ligamentum flavum. Spine 15:1114–1120

    Article  CAS  PubMed  Google Scholar 

  9. Kawahara N, Tomita K, Murakami H et al (2008) Circumspinal decompression with dekyphosis stabilization for thoracic myelopathy due to ossification of the posterior longitudinal ligament. Spine 33:39–46

    Article  PubMed  Google Scholar 

  10. Yeung AT, Tsou PM et al (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome and complications in 307 consecutive cases. Spine 27:722–731

    Article  PubMed  Google Scholar 

  11. Oertel JM, Philipps M, Burkhardt BW (2016) Endoscopic posterior cervical foraminotomy as a treatment for osseous foraminal stenosis. World Neurosurg 91:50–57

    Article  PubMed  Google Scholar 

  12. Atsushi S, Susumu N et al (2003) Image-guided resection for thoracic ossification of the ligamentum flavum. Journal of Neurosurgery J Neurosurg 99(1 Suppl):60–63

    Google Scholar 

  13. Yukihiro M, Hisatake Y, Taichi T et al (2005) Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options. J Spinal Disord Tech 18(6):492–497

    Article  Google Scholar 

  14. Nie ZH, Liu FJ, Shen Y et al (2013) Lamina osteotomy and replantation with miniplate fixation forthoracic myelopathy due to ossification of the ligamentum flavum. Orthopedics 36(3):e353–e359

    Article  PubMed  Google Scholar 

  15. Tokuhashi Y, Matsuzaki H, Oda H et al (2006) Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine: usefulness of the ossification-kyphosis angle on MRI. Spine (Phila Pa 1976) 31(1):E26–E30

    Article  Google Scholar 

  16. Aizawa T, Sato T, Sasaki H et al (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  PubMed  Google Scholar 

  17. Matsumoto M, Chiba K, Toyama Y et al (2008) Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine: a multi-institutional retrospective study. Spine 20:1034–1041

    Article  Google Scholar 

  18. Young WF, Baron E (2001) Acute neurologic deterioration after surgical treatment for thoracic spinal stenosis. J Clin Neuro sci 8(2):129–132

    Article  CAS  Google Scholar 

  19. Yamazaki M, Koda M, Okawa A et al (2006) Transient paraparesis after laminectomy for thoracic ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum. Spinal Cord 44:130–134

    Article  CAS  PubMed  Google Scholar 

  20. Min JH, Jang JS, Lee SH (2008) Clinical results of ossification of the posterior longitudinal ligament of the thoracic spine treated by anterior decompression. J Spinal Disord Tech 21:116–119

    Article  PubMed  Google Scholar 

  21. Eggspuehler A, Sutter MA, Grob D, Porchet F (2007) Multimodal intraoperative monitoring (MIOM) during surgical decompression of thoracic spinal stenosis in 36 patients. Eur Spine J 16 Suppl 2:S216–S220

    Article  Google Scholar 

  22. Liu XG, Liu ZG, Chen ZQ et al (2010) “Cave-in” technique: 360° circumferential decompression for thoracic spinal stenosis with ossification of posterior longitudinal ligament. Chinese Journal of Orthopaedics 30(11):1059–1062

    CAS  Google Scholar 

  23. Cho JY, Chan CK, Lee SH et al (2012) Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine: the utilization of a volume-controlled pseudomeningocele. J Spinal Disord Tech 25(4):E93-102

    Article  PubMed  Google Scholar 

  24. Wiggins GC, Shaffrey CI (2007) Dorsal surgery for myelopathy and myeloradiculopathy. Neurosurgery 60(1 Supp1 1):S71–S81

    PubMed  Google Scholar 

  25. Fan G, Wang T, He S (2017) Navigation improves the learning curve of transforamimal percutaneous endoscopic lumbar discectomy. Int Orthop 41(2):323–332

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Mini-invasive Spinal Surgery, Third Hospital of Henan Province, NO198 Funiu Road, Zhengzhou, 450000, China

    Zhao Xiaobing, Li Xingchen, Zhou Honggang, Cao Xiaoqiang, Yuan Qidong, Ma Haijun, Yang Hejun & Wang Bisheng

Authors
  1. Zhao Xiaobing
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li Xingchen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhou Honggang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cao Xiaoqiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuan Qidong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ma Haijun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yang Hejun
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wang Bisheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Li Xingchen.

Ethics declarations

Competing interests

The authors declare that they have no conflict of interest.

Additional information

Zhao Xiaobing is the first author

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xiaobing, Z., Xingchen, L., Honggang, Z. et al. “U” route transforaminal percutaneous endoscopic thoracic discectomy as a new treatment for thoracic spinal stenosis. International Orthopaedics (SICOT) 43, 825–832 (2019). https://doi.org/10.1007/s00264-018-4145-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-018-4145-y

Keywords

Search

Navigation