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Subsection Laminectomy with Pedicle Screw Fixation to Treat Thoracic Ossification of Ligamentum Flavum: A Comparative Analysis with Lamina Osteotomy and the Replantation Technique

Authors Zhang J, Lei T, Yang L, Lin YS, Wang ZH, Cao JM

Received 24 October 2019

Accepted for publication 4 March 2020

Published 17 April 2020 Volume 2020:16 Pages 311—319

DOI https://doi.org/10.2147/TCRM.S235868

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Deyun Wang


Jing-tao Zhang, Tao Lei, Liu Yang, Yong-Sheng Lin, Zhi-Hong Wang, Jun-Ming Cao

Department of Orthopedics, The Third Hospital of HeBei Medical University, Shijiazhuang, People’s Republic of China

Correspondence: Jun-Ming Cao
Department of Orthopedics, The Third Hospital of HeBei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, People’s Republic of China
Tel +86-311-88602016
Fax +86-311-87023626
Email junmingcao6@163.com

Background: There are many surgical procedures that can be used to relieve compression caused by thoracic ossification of the ligamentum flavum (TOLF). The present study aims to retrospectively observe the differences in subsection laminectomy with pedicle screw fixation (SLPF) and lamina osteotomy and replantation with miniplate fixation (LORF) in the treatment of continuous TOLF.
Patients and Methods: From March 2014 to October 2017, 61 patients with continuous TOLF underwent SLPF (group A) or LORF (group B). The surgical duration, intraoperative blood loss, change in thoracic kyphosis, and perioperative complications were analyzed. Neurological function was evaluated in accordance with the Japanese Orthopedic Association (JOA) score and the American Spinal Injury Association (ASIA) neurological grading.
Results: The surgical duration, intraoperative blood loss, and postoperative bed-rest duration in group A were significantly lower than those observed in group B (P < 0.05). Both groups demonstrated a significant improvement in JOA score and ASIA grade (P < 0.05). The neurological recovery rate was 69.8% ± 13.5% in group A and 68.5% ± 12.7% in group B (P > 0.05). There was also a significant improvement in ASIA grade at the final follow-up (P < 0.05). During follow-up, the Cobb angle was significantly increased in group B (P < 0.05), whereas no significant difference was observed in group A (P > 0.05). The occurrence rate of perioperative complications was 15.6% (5/32 patients) in group A and 37.9% (11/29 patients) in group B (P < 0.05).
Conclusion: Both SLPF and LORF significantly promote recovery of neurological function. SLPF has a shorter surgical duration, less intraoperative blood loss, and a lower complication rate. SLPF is more conducive to the correction of sagittal sequence and maintenance of thoracic stability.

Keywords: thoracic ossification of the ligamentum flavum, thoracic vertebra, posterior decompression, internal fixation, therapeutic effect analysis

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