Laminar shelling decompression for treatment of thoracic spinal stenosis

嚴(yán) 寧(Yang Ning， Dept Orthop，Pudong Hosp，Shanghai 200433)…∥Chin J Orthop.－2010，30(11).－1048～1052

Laminar shelling decompression for treatment of thoracic spinal stenosis

嚴(yán) 寧(Yang Ning， Dept Orthop，Pudong Hosp，Shanghai 200433)…∥Chin J Orthop.－2010，30(11).－1048～1052

ObjectiveTo investigate the clinical characteristics of laminar shelling decompression for the treatment of thoracic spinal stenosis.MethodsOne hundred and twenty-one patients with thoracic spinal stenosis were reviewed.Ages of these 51 male and 70 female patients ranged from 45 to 71 years(mean 54.8 years).There were 72 patients with thoracic ossification of ligamentum flavum(OLF)，21 patients with thoracic ossification of posterior longimental ligament(OPLL)and 28 patients with thoracic OLF and OPLL.The lesion segmentum，kyphosis angle of thoracic vertebra and residual area of vertebral canal(RAVC)were measured.All these patients were treated with laminar shelling decompression.Preoperative and postoperative functional statuses were evaluated using a Japanese Orthopaedic Association(JOA)score.ResultsThoracic OLF were found between T7to T12in 77.0%of the lesions;thoracic OPLL were found between T1to T6in 81.1%of the lesions.Of the 121 pa-tients，the mean kyphosis angle was 31.5°±6.8°in upper thoracic spine and，9.4°± 3.5°in lower thoracic spine.In patients whose RAVC were more than 80% ，the pre-and postoperative mean JOA score was 7.7 ± 1.4 and 9.5 ± 1.6 respectively;RAVC more than 50%，5.2±1.8 and 8.6 ±2.1 respectively;RAVC less than 5%，4.8 ± 1.4，and 5.6 ± 1.3 respectively.ConclusionThoracic OLF mostly occurred in lower thoracic spine，while thoracic OPLL mostly occurred in upper thoracic spine.The RAVC is a significant factor to the prognosis of thoracic spinal stenosis.As long as the clinical symptoms correspond with imaging findings，it is better to resect the whole ossification part as much as possible.Thoracic spinal stenosis often recurs after surgery.More attention to decompression ranges and decompression skills shoud be paid during revision surgery.15 refs，2 figs，4 tabs.

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