DECOMPRESSION BY THINNING-OUT A BEAK-TYPE OSSIFICATION OF THORACIC POSTERIOR LONGITUDINAL LIGAMENT, A CASE REPORT
Abstract
Introduction: Ossification of posterior longitudinal ligament (OPLL) is commonly caused dysfunction of the spinal cord. The conservative therapy has been proved to be ineffective and surgical treatment is often needed. Accessing the anterior border of OPLL for anterior decompression while ensuring safe decompression of spinal cord are technical challenges for the treatment. The objectives of this case report is to introduce a surgical technique of decompression and decided whether it is an effective surgical technique to treat a beak type thoracic OPLL, especially in T9-10.
Methods: We reported a male, 38 years old, who were admitted to Cipto Mangunkusumo hospital in 2016 and was diagnosed as paraparesis due to OPLL at the level of T9-10.
Results and Discussion: Surgical decompression was performed from a posterior approach. The left facet, pedicle of T9, and the distal part of T9 vertebral body were removed using highspeed burr until the interval of calcified area was reached distally. Thinning of the calcified area was done until paper thin and expansion of the dura and spinal cord can be observed. The decompression procedure was followed by stabilization of T7-11 using pedicle screws and rods. No worsening of the neurological symptoms was observed post operatively. The patient could stand and assisted walk in day 3 post operation.
Conclusion:. This surgical procedure has been shown to be an effective therapy and achieves satisfactory clinical outcomes for patients.
Keywords: thoracic ossification of posterior longitudinal ligament, beak type thoracic OPLL, Surgical Treatment, decompression with posterior approach.
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Gu Y, Shi J, Cao P, Yuan W, Wu H, Yang L, et al. Clinical and imaging predictors of surgical outcome in multilevel cervical ossification of posterior longitudinal ligament: An analysis of 184 patients. PLoS One. 2015;10(9):1–15.
Abiola R, Rubery P, Mesfin A. Ossification of the posterior longitudinal ligament: Etiology, diagnosis, and outcomes of nonoperative and operative management. Glob Spine J. 2016;6(2):195–204.
Matsunaga S, Sakou T. OPLL: Disease entity, incidence, literature search, and prognosis. 2006;11–7.
Yang B, Wang Y, He X, Li H. Treatment for thoracic ossification of posterior longitudinal ligament with posterior circumferential decompression: complications and managements. J Orthop Surg Res. 2016;11(1):153.
Kudo H, Furukawa K-I, Yokoyama T, Ono A, Numasawa T, Wada K, et al. Genetic differences in the osteogenic differentiation potency according to the classification of ossification of the posterior longitudinal ligament of the cervical spine. Spine. 2011;36(12):951–7.
Baaj AA, Smith DA, Vale FL, Uribe JS. Surgical approaches to thoracic ossification of the posterior longitudinal ligament. J Clin Neurosci. 2012;19(3):349–51.
Baaj AA, Smith DA, Vale FL, Uribe JS. Surgical approaches to thoracic ossification of the posterior longitudinal ligament. J Clin Neurosci. 2012;19(3):349–51.
Zhang HQ, Chen LQ, Liu SH et al. 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. 2010;13:116–22.
Nishida N, Kanchiku T, Kato Y, Imajo Y, Suzuki H, Yoshida Y, et al. Cervical ossification of the posterior longitudinal ligament: factors affecting the effect of posterior decompression. J Spinal Cord Med. 2017;40(1):93–9.
Yang B, Wang Y, He X, Li H. Treatment for thoracic ossification of posterior longitudinal ligament with posterior circumferential decompression: complications and managements. J Orthop Surg Res. 2016;11(1):153..
Press D. A higher frequency of lumbar ossification of the posterior longitudinal ligament in elderly in an outpatient clinic in Japan. 2013;729–32.
Mizuno J, Nakagawa H. Ossified posterior longitudinal ligament: management strategies and outcomes. Spine J. 2006;6:282–8.
Ren Y, Liu ZZ, Feng J, et al. Association of a BMP9 haplotype with ossification of the posterior longitudinal ligament (OPLL) in a Chinese population. PLoS ONE 2012;7(7):4058
Nakajima M, Takahashi A, Tsuji T, et al; Genetic Study Group of Investigation Committee on Ossification of the Spinal Ligaments. A genome-wide association study identifies susceptibility loci for ossification of the posterior longitudinal ligament of the spine. Nat Genet. 2014;46(9):1012–6.
Ren Y, Feng J, Liu ZZ, Wan H, Li JH, Lin X. A new haplotype in BMP4 implicated in ossification of the posterior longitudinal ligament (OPLL) in a Chinese population. J Orthop Res 2012;30(5):748–75.
Lee S, Peters C, Riew KD. Cervical myeloradiculopathy due to ossification of the posterior longitudinal ligament with versus without diffuse idiopathic spinal hyperostosis. 2016;350–6.
Ch SA, Malik AL, Khan TQ. Original Article Spine-A Recognize Cause of Myelopathy in Pakistan. 2012;22:40–3.
Ando K, Imagama S, Ito Z, Kobayashi K, Ukai J, Muramoto A, et al. Progressive relapse of ligamentum flavum ossification following decompressive surgery. Asian Spine J. 2014;8(6):835–9.
Chen Y, Liu X, Chen D, Wang X, Yuan W. Surgical strategy for ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics. 2012;35(8):1231-7.
Yamazaki M, Okawa A, Fujiyoshi T, et al. Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament. Eur Spine J 2010;19:691–8
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