scholarly journals Anterior Decompression via a Single Posterior Approach Using the Ultrasonic Bone Scalpel for the Treatment of the Thoracic Segmental Ossification of Posterior Longitudinal Ligament: A Report of Three Cases

2021 ◽  
Author(s):  
Motohiro Okada ◽  
Yukihiro Nakagawa ◽  
Munehito Yoshida ◽  
Hiroshi Yamada
Keyword(s):  
Posterior Approach ◽  
Posterior Longitudinal Ligament ◽  
Anterior Decompression ◽  
Single Posterior Approach

Novel surgical technique for ossification of posterior longitudinal ligament in the thoracic spine

2012 ◽  
Vol 17 (6) ◽  
pp. 525-529 ◽  
Author(s):  
Satoshi Kato ◽  
Hideki Murakami ◽  
Satoru Demura ◽  
Katsuhito Yoshioka ◽  
Hiroyuki Hayashi ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Complete Removal ◽  
Posterior Longitudinal Ligament ◽  
Technical Note ◽  
Anterior Decompression ◽  
Total Resection ◽  
Novel Technique ◽  
Dural Sac ◽  
Single Posterior Approach ◽  
Posterior Instrumented Fusion

Several surgical procedures have been developed to treat thoracic ossification of the posterior longitudinal ligament (OPLL). However, favorable surgical results are not always achieved, and consistent protocols and procedures for surgical treatment of thoracic OPLL have not been established. This technical note describes a novel technique to achieve anterior decompression via a single posterior approach. Three patients with a beak-type thoracic OPLL underwent surgery in which the authors' technique was used. Complete removal of the ossified PLL was achieved in all cases. With the patient in the prone position, the authors performed total resection of the posterior elements at the anterior decompression levels. This maneuver included not only laminectomies but also removal of the transverse processes and pedicles, which allowed space to be created bilaterally at the sides of the dural sac for the subsequent anterior decompression. The thoracic nerves at the levels of anterior decompression were ligated bilaterally and lifted up to manipulate the ossified ligament and the dural sac. An anterior decompression was then performed posteriorly. The PLL was floated without any difficulty. After exfoliation of the adhesions between the ossified ligament and the ventral aspect of the dural sac, the ossified PLL was removed. In every step of the anterior decompression, the space created in the bilateral sides of the dural sac allowed the surgeons to see the OPLL and anterolateral aspect of the dural sac directly and easily. After removal of the ossified PLL, posterior instrumented fusion was performed. This surgical procedure allows the surgeon to perform, safely and effectively, anterior decompression via a posterior approach for thoracic OPLL.

Anterior decompression through a posterior approach for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a novel concept in anterior decompression and technical notes with the preliminary outcomes

2021 ◽  
pp. 1-11
Author(s):  
Haruo Kanno ◽  
Toshimi Aizawa ◽  
Ko Hashimoto ◽  
Eiji Itoi ◽  
Hiroshi Ozawa
Keyword(s):  
Surgical Technique ◽  
Posterior Approach ◽  
Perioperative Complications ◽  
Posterior Longitudinal Ligament ◽  
Anterior Decompression ◽  
Thoracic Myelopathy ◽  
Posterior Portion ◽  
Vertebral Bodies ◽  
Novel Concept

OBJECTIVE Various surgical procedures are used to manage thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). However, the outcomes of surgery for thoracic OPLL are generally unfavorable in comparison to surgery for cervical OPLL. Previous studies have shown a significant risk of perioperative complications in surgery for thoracic OPLL. Thus, a safe and secure surgical method to ensure better neurological recovery with less perioperative complications is needed. The authors report a novel concept of anterior decompression through a posterior approach aimed at anterior shift of the OPLL during surgery rather than extirpation or size reduction of the OPLL. This surgical technique can securely achieve anterior shift of the OPLL using a curved drill, threadwire saw, and curved rongeur. The preliminary outcomes were investigated to evaluate the safety and efficacy of this technique. METHODS This study included 10 consecutive patients who underwent surgery for thoracic OPLL. Surgical outcomes, including the ambulatory status, Japanese Orthopaedic Association (JOA) score, and perioperative complications, were investigated retrospectively. In this surgery, pedicle screws are introduced at least three levels above and below the corresponding levels. The laminae, facet joints, transverse processes, and pedicles are then removed bilaterally at levels wherein subsequent anterior decompression is performed. For anterior decompression, the OPLL and posterior portion of the vertebral bodies are partially resected using a high-speed drill with a curved burr, enabling the removal of osseous tissues just ventral to the spinal cord without retracting the dural sac. To securely shift the OPLL anteriorly, the intact PLL and posterior portion of the vertebral bodies cranial and caudal to the lesion are completely resected using a threadwire saw and/or curved rongeur. Rods are connected to the screws, and bone grafting is performed for posterolateral fusion. RESULTS Five patients were nonambulatory before surgery, but all were able to walk at the final follow-up. The average JOA score before surgery and at the final follow-up was 3.2 and 8.8 points, respectively. Notably, the mean recovery rate of JOA score was 72%. Furthermore, no patients showed neurological deterioration postoperatively. CONCLUSIONS The surgical technique is a useful alternative for safely achieving sufficient anterior decompression through a posterior approach and may consequently reduce the risk of postoperative neurological deterioration and improve surgical outcomes in patients with thoracic OPLL.

Surgical treatment of lumbar ossification of the posterior longitudinal ligament

2005 ◽  
Vol 3 (3) ◽  
pp. 230-233 ◽  
Author(s):  
Mutsuhiro Tamura ◽  
Masafumi Machida ◽  
Daisuke Aikawa ◽  
Kentaro Fukuda ◽  
Hitoshi Kono ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Posterior Longitudinal Ligament ◽  
The Other ◽  
Content Type ◽  
Posterior Surgery ◽  
The Individual ◽  
Single Posterior Approach ◽  
Anterior Posterior ◽  
Fine Print

✓ The authors report two cases of patients with lumbar ossification of the posterior longitudinal ligament (OPLL). One patient underwent surgery via the single posterior approach, and the other patient underwent combined anterior—posterior surgery. The authors consider the anterior approach for excision of the ossified lesion to be the most reasonable for treatment of lumbar OPLL. It is extremely important, however, to select the surgical procedure according to the individual patient's condition.

scholarly journals Reduction and fusion in high-grade L5-S1 spondylolisthesis by a single posterior approach. Results in 50 patients

2016 ◽  
Vol 102 (2) ◽  
pp. 233-237 ◽  
Author(s):  
S. Moreau ◽  
G. Lonjon ◽  
P. Guigui ◽  
T. Lenoir ◽  
C. Garreau de Loubresse ◽  
...  
Keyword(s):  
Posterior Approach ◽  
High Grade ◽  
Single Posterior Approach

Minimally invasive tubular surgery for transforaminal lumbar interbody fusion

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video19 ◽  
Author(s):  
Jon Kimball ◽  
Andrew Yew ◽  
Ruth Getachew ◽  
Daniel C. Lu
Keyword(s):  
Minimally Invasive ◽  
Posterior Approach ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Postoperative Patient ◽  
Common Procedure ◽  
Circumferential Fusion ◽  
Single Posterior Approach ◽  
Invasive Techniques

Transforaminal lumbar interbody fusion (TLIF) was originally developed as a method for circumferential fusion via a single posterior approach and is now an extremely common procedure for the treatment of lumbar instability. More recently, minimally invasive techniques have been applied to this procedure with the goal of decreasing tissue disruption, blood loss and postoperative patient discomfort. Here we describe a minimally invasive tubular TLIF on a 60-year-old male with radiculopathy from an unstable L4–5 spondylolisthesis.The video can be found here: http://youtu.be/0BbxQiUmtRc.

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