Minimally Invasive Anterior Decompression Technique without Instrumented Fusion for Huge Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine: Technical Note And Literature Review

Transdural circumferential decompression for thoracic spinal stenosis caused by beak-type ossification of the posterior longitudinal ligament: a technical note

PURPOSE

Thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine is usually progressive and responds poorly to conservative therapy, making surgery the only effective treatment option. A variety of surgical procedures have been developed to treat thoracic OPLL. However, the optimal surgical approach for removal of thoracic OPLL remains unclear. In the present study, we described a newly modified posterior approach for the removal of OPLL: circular decompression via dural approach, and complete removal of OPLL can be achieved under direct vision and without neurological deficit.

MATERIALS AND METHODS

Three patients with beak-type thoracic OPLL presented with progressive thoracic myelopathy and leg weakness. Magnetic resonance imaging showed the spinal cord severely compressed. The surgical management of the three patients involved the 'cave-in' circular decompression and transdural resection of OPLL.

RESULTS

Transdural circumferential decompression was successfully performed in all three patients. Clinical outcome measures, including pre- and postoperative radiographic parameters, were assessed. All of the patients were followed up for an average of 12 months (ranging from 10 to 15 months), and no surgery-related complications occurred. Weakness relief and neural function recovery were satisfactorily achieved in all patients by the final follow-up.

CONCLUSIONS

Transdural circumferential decompression was an effective method for thoracic spinal stenosis caused by concurrent beak-type OPLL, by which OPLL could be safely removed. It is especially useful when there is a severe adhesion between the dura OPLL.

A feasibility study of modified self-efficacy for the improvement of adverse emotions and quality of life in traumatic fracture patients

OBJECTIVE

To investigate the changes in the adverse psychologies and psychological coping at the late stage of self-efficacy intervention in traumatic fracture patients.

METHODS

A total of 80 traumatic fracture patients admitted to our hospital were recruited as the study cohort and randomly divided into two groups. The control group (n=40) underwent conventional post-fracture nursing, and the study group (n=40) underwent self-efficacy intervention combined with conventional post-fracture nursing. After the intervention, the changes in the anxiety and depression, self-efficacy, quality of life, and the psychological coping scores were assessed and compared between the two groups. Finally, the correlations among the self-efficacy, adverse emotions, and psychological coping scores were analyzed.

RESULTS

Before the intervention, there was no marked difference in the anxiety and depression, self-efficacy, life satisfaction, and psychological coping scale scores between the two groups (P > 0.05). At 1, 3, and 6 months after the intervention, the study group had remarkably lower hospital anxiety and depression scale (HADS) scores and significantly higher self-efficacy, quality of life and psychological coping scale scores than the control group (P < 0.05). The correlation analysis showed that the general self-efficacy scale (GSES) scores were negatively correlated with the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) scores (r=-0.8623, r=-0.6895, P < 0.05) and were positively correlated with the psychological coping scale scores (r=0.7196, P < 0.05).

CONCLUSION

Self-efficacy intervention can markedly improve the adverse emotions and the self-efficacy and quality of life scores in traumatic fracture patients. The patients' self-efficacy is significantly positively correlated with the psychological coping scores. Therefore, self-efficacy intervention can be implemented to improve the traumatic coping abilities of traumatic fracture patients.

The COL6A1 rs201153092 single nucleotide polymorphism, associates with thoracic ossification of the posterior longitudinal ligament

Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is one of the most common factors that causes thoracic spinal stenosis, resulting in intractable myelopathy and radiculopathy. Our previous study reported that the rs201153092 polymorphism present in the collagen 6A1 (COL6A1) gene was a potentially pathogenic locus for the development of T-OPLL. The present study aimed to determine whether the rs201153092 mutation causes abnormal expression of COL6A1 in Han Chinese patients with T-OPLL, and to examine the effects of this mutation on osteogenesis by establishing a model of osteogenic differentiation. COL6A1 gene mutant and wild-type mouse 3T3-E1 embryonic osteoblast models were constructed to induce the differentiation of these cells into osteoblasts. The potential of the mutation site to induce abnormal expression of the COL6A1 gene and osteogenic markers was assessed via reverse transcription-quantitative PCR and western blot analyses. The results demonstrated that the rs201153092A mutation site resulted in significantly increased COL6A1 gene expression levels in the OPLL tissues obtained following clinical surgery. This mutation was shown to play an important role in the development of T-OPLL by regulating the overexpression of the COL6A1 gene and significantly increasing the expression levels of osteogenic markers. The findings of the present study suggested that the rs201153092A mutant variant could increase the expression levels of COL6A1 and consequently play a role in the pathogenesis of T-OPLL.

Microsurgical resection of ossification of the posterior longitudinal ligament in the thoracic spine via the transthoracic approach without spinal fusion: case series and technical note

OBJECTIVE

Surgical management of thoracic ossification of the posterior longitudinal ligament (OPLL) remains challenging because of the anatomical complexity of the thoracic spine and the fragility of the thoracic spinal cord. Several surgical approaches have been described, but it remains unclear which of these is the most effective. The present study describes the microsurgical removal of OPLL in the middle thoracic level via the transthoracic anterolateral approach without spinal fusion, including the surgical outcome and operative tips.

METHODS

Between 2002 and 2017, a total of 8 patients with thoracic myelopathy due to OPLL were surgically treated via the transthoracic anterolateral approach without spinal fusion. The surgical techniques are described in detail. Clinical outcome, surgical complications, and the pre- and postoperative thoracic kyphotic angle were assessed.

RESULTS

The mean patient age at the time of surgery was 55 years (range 47-77 years). There were 5 women and 3 men. The surgically treated levels were within T3-9. The clinical symptoms and Japanese Orthopaedic Association (JOA) score improved postoperatively in 7 cases, but did not change in 1 case. The mean JOA score increased from 6.4 preoperatively to 7.5 postoperatively (recovery rate 26%). Intraoperative CSF leakage occurred in 4 cases, and was successfully treated with fibrin glue sealing and spinal drainage. The mean follow-up period was 82.6 months (range 15.3-169 months). None of the patients had deterioration of the thoracic kyphotic angle.

CONCLUSIONS

Anterior decompression is the logical and ideal procedure to treat thoracic myelopathy caused by OPLL on the concave side of the spinal cord; however, this procedure is technically demanding. Microsurgery via the transthoracic anterolateral approach enables direct visualization of the thoracic ventral ossified lesion. The use of microscopic procedures might negate the need for bone grafting or spinal instrumentation.