| Objective: Traditional open decompression surgery for the treatment of thoracic ligamentum flavum ossification has many complications,such as dural tears,neurological damage,internal fixation disorders,etc.,and patients are not satisfied with open surgery.The treatment of lumbar spinal stenosis under spinal endoscopy has achieved satisfactory results.This operation can also be used for the treatment of thoracic ligamentum flavum ossification(TOLF)under local anesthesia.The purpose of this study was to compare the surgical efficacy of the retrolaminar approach for the treatment of single/double-segment thoracic ossification of the ligamentum flavum and open surgery,and to analyze its complications.Methods: The data of 25 patients diagnosed with ossification of the thoracic ligamentum flavum and undergoing surgical treatment were collected from January 2016 to December 2020 in the Department of Spine and Bone Diseases of our hospital.Among them,11 cases underwent translaminar approach endoscopic surgery as the experimental group,and 14 cases underwent traditional posterior open surgery as the control group.The operation time,hospital stay,blood loss,VAS,ODI,JOA score difference in each period before and after the operation(difference A = score on the 3rd day after surgery-preoperative score,difference B = last follow-up score after surgery-surgery Previous score,difference C = last follow-up score after surgery-score on the 3rd day after surgery),postoperative modified Mac Nab score,complications,etc.were statistically analyzed.Results: Twenty-five cases of thoracic ligamentum flavum ossification that met the criteria and had complete data were included and followed up for 5-48 months.The blood loss,hospitalization time,and operation time of the experimental group were82.00±40.96 ml,6.82±1.40 days,and 84.45±20.85 min,respectively.The blood loss,hospitalization time,and operation time of the control group were174.78±45.58 ml,9.00±2.86 days,90.71±24.37 min,respectively.there was a statistically significant difference in blood loss and hospital stay between the two groups(p<0.05),while the difference in operation time was not statistically significant(p>0.05).The difference A of VAS,ODI and JOA in the experimental group were-(3.73±1.35)points,-(25.73±4.50)points,12.00±2.79 points,and the difference A of VAS,ODI and JOA in the control group were-(2.07)±0.83)points,-(15.64±5.17)points,7.29±1.27 points,the difference between the two groups was statistically significant(p<0.05).The difference B of VAS,ODI,JOA in the experimental group was-(4.09±0.45)points,-(29.45±3.96),12.00±3.03 points,and the difference B of VAS,ODI,JOA in the control group was-(3.50 ±0.86)points,-(26.36±3.37)points,10.36±2.10 points,the difference in ODI B between the two groups is statistically significant(p=0.045),but there is no difference in the difference B between VAS and JOA between the two groups Statistical significance(p>0.05).The difference C of VAS,ODI and JOA in the experimental group were-(0.36±0.51),-(3.37±1.85),0.00±2.15,and the difference C of VAS,ODI and JOA in the control group were-(1.43 ±0.76)points,-(10.71±3.43)points,3.07±1.90 points,the difference between the two groups was statistically significant(p<0.05).The JOA improvement rate of the experimental group was 0.65±0.15,and the modified Mac Nab efficacy score at the last follow-up after operation was excellent in 7 cases,good in 3 cases,and fair in 1 case.The excellent and good rate was about 90.91%(10/11).The JOA improvement rate of the control group was 0.56±0.08,and the modified Mac Nab efficacy score at the last follow-up after operation: excellent in 6 cases,good in6 cases,and fair in 2 cases.The excellent and good rate was about 85.71%(12/14).The complication rate in the experimental group was about 27.27%(3/11).The incidence of complications in the control group was about 35.71%(5/14).Conclusions: The retrolaminar approach endoscopic treatment of single/double-segment TOLF has a good effect.Compared with the traditional open posterior approach,it has the advantages of fewer complications,faster recovery,less bleeding,and shorter hospital stay. |
PDF Full Text Request