Application of graded decompression surgical strategy based on the risk of dural ossification for thoracic ossification of the ligamentum flavum
Objective:To investigate the efficacy of graded decompression surgical strategy based on the risk of dural ossification(DO)in the treatment of thoracic ossification of the ligamentum flavum(TOLF).Methods:The clinical data of 51 TOLF patients treated with graded decompression surgical strategy at Peking Union Medical College Hospital from January 2017 to February 2023 were retrospectively analyzed.Patients were preoperatively divided into low-risk and high-risk groups based on DO risk.Age,gender,body mass index(BMI),clinical symptoms,signs,surgical segments,intraoperative blood loss,postoperative drainage time,and postoperative cerebrospinal fluid leakage(CSFL)were collected in the two groups.Additionally,the preoperative and postoperative neurological function of the patients was evaluated using the Japanese Orthopedic Association(JOA)score and the recovery rate(RR).Results:Among the 51 patients,38 were in the low-risk group,and 13 were in the high-risk group.The proportion of patients with lower limb pain was significantly higher in the low-risk group than in the high-risk group(39.5%[15/38]vs.7.7%[1/13])(P<0.05).There was no significant difference between the two groups in age,gender,BMI,preoperative or postoperative JOA score,or RR(all P>0.05).The number of surgical segments and intraoperative blood loss were greater in the high-risk group than in the low-risk group,and the postoperative drainage time was significantly longer in the high-risk group than in the low-risk group(P<0.05).In addition,the incidence of CSFL in the high-risk group was significantly higher than that in the low-risk group(P<0.001).Conclusions:This study proposes a new surgical strategy for treating TOLF patients based on DO risk,which has the advantages of reducing the incidence of postoperative CSFL in TOLF patients and reducing the adverse effects of DO on neurological recovery.
Thoracic Ossification of the Ligamentum FlavumDural OssificationGraded decompressionCerebrospinal fluid leakageNeurological Function
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