J Minim Invasive Spine Surg Tech.  2023 Jul;8(Suppl 1):S72-S77. 10.21182/jmisst.2023.00724.

Use of Microscopic Tubular Decompression in Thoracic Ossification of the Ligamentum Flavum: A Retrospective Analysis of Outcomes

• Kulkarni AG
• Patil SR
• Sharma S

• KMID: 2562187
• DOI: http://doi.org/10.21182/jmisst.2023.00724

Abstract

Objective
This study retrospectively analyzed the outcomes of microscopic tubular decompression (MTD) in thoracic spinal stenosis due to ossification of the ligamentum flavum.
Methods
Twelve patients who had symptomatic thoracic spinal stenosis with or without co-existing spinal stenosis at other spinal regions were included in the study. The inclusion criteria were complaints of numbness or paresthesia below the affected level, gait difficulties, back pain, hyperreflexia and increased muscle tone upon clinical examination with magnetic resonance imaging evidence of ligamentum flavum thickening resulting in thoracic canal stenosis. The whole spine was evaluated for tandem stenosis. Patients with other causes of thoracic spinal stenosis due to a tumor or malignancy and multiple-level thoracic spinal stenosis were excluded.
Results
The patients’ mean age was 59 years. There were 9 men and 3 women. The average duration of symptoms was 8.6 months, and the average follow-up period was 15.4 months. The mean preoperative Nurick score was 3.83 and mean postoperative Nurick score was 1.5. Postoperatively, 1 patient presented with bilateral lower limb weakness due to local hematoma, which was promptly evacuated with open decompression.
Conclusion
MTD allows a magnified surgical field while minimizing disruption to the surrounding soft tissue and bone structures and enables complete decompression of the spinal cord with minimal alteration to the biomechanical strength of the vertebral column. The advantages of tubular decompression include decreased blood loss, reduced hospital stay, early mobilization, and less muscle injury. Rapid recovery from surgical treatment is another potential advantage of this approach.

Keyword

Diskectomy; Paresthesia; Laminectomy; Microscopic spine surgery; Tubular decompression; Canal stenosis; Tubular retractors; Disc herniation; Ossification ligamentum flavum