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      Role of lordotic rod contouring in thoracic myelopathy: a technical note

      case-report

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          Abstract

          Introduction

          Decompressive surgery for thoracic myelopathy due to anterior pathology can be challenging. Direct decompression through anterior approaches is associated with approach-related complications, whereas anterior decompression through posterior approaches is technically demanding and may result in neurological deterioration. We present a simple and effective surgical technique of indirect decompression through lordotic rod contouring to reduce such complications.

          Case presentation

          Patients who presented to our center between March 2016 and March 2017 with symptoms and signs suggestive of thoracic myelopathy predominantly due to anterior pathologies such as ossification of the thoracic posterior longitudinal ligament, posterior bony spur, and thoracic disc herniation were evaluated in our study. The indications for surgical treatment were progressive neurological impairment and severe myelopathy (grade III or more on Nurick grade). Only those patients classified as grade III and above on American Society of Anaesthesiologists (ASA) physical status scale were included in the study. All the cases were operated by a single surgeon by a posterior-only approach. We have used this technique in four patients with thoracic myelopathy due to combined or predominant anterior pathology. Postoperative imaging confirmed adequate decompression of the spinal cord. All the cases improved substantially in terms of clinical outcome.

          Discussion

          This surgical technique could be a useful alternative to direct anterior decompression in patients who present with symptoms of progressive severe myelopathy due to anterior compression and could be the standard of care in those at high risk for major surgery.

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          Most cited references14

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          Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament.

          A retrospective review.
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            Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion.

            This retrospective study was conducted to investigate the clinical outcomes of several surgical procedures for thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL).
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              Thoracic myelopathy secondary to ossification of the spinal ligament.

              The authors describe their experience with 26 cases of thoracic myelopathy secondary to hypertrophic ossification of the spinal ligament (posterior longitudinal ligament and/or ligamentum flavum). The clinical manifestations of this condition and results of its surgical treatment are described. The commonest symptoms were numbness or tingling in the legs and feet and gait disturbance. Most of the patients with involvement of the upper thoracic spine showed typical features of thoracic myelopathy: that is, sensory and motor deficits in both the trunk and lower extremities, sphincter disturbance, and exaggerated tendon reflexes. Several patients with involvement of the thoracolumbar junction presented with atypical symptoms of thoracic myelopathy and were sometimes misdiagnosed and treated inappropriately. Surgical treatment, particularly laminectomy, was not always successful. Inconsistencies in the surgical outcome were caused by either operative complications or reversal of the initial improvement during the follow-up period. The results of anterior surgery for the condition were more favorable; however, use of this procedure was rarely indicated.
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                Author and article information

                Contributors
                +91-9597732908 , kalyanvarmambbs@gmail.com
                Journal
                Spinal Cord Ser Cases
                Spinal Cord Ser Cases
                Spinal Cord Series and Cases
                Nature Publishing Group UK (London )
                2058-6124
                22 August 2019
                2019
                : 5
                : 74
                Affiliations
                ISNI 0000 0004 1800 5096, GRID grid.464889.f, Indian Spinal Injuries Center, Vasant Kunj, ; New Delhi, 110070 India
                Article
                218
                10.1038/s41394-019-0218-4
                6786501
                31632732
                5eac3c80-9dd0-4904-be8e-d8a603e59490
                © International Spinal Cord Society 2019
                History
                : 13 May 2019
                : 29 July 2019
                : 3 August 2019
                Categories
                Case Report
                Custom metadata
                © The Author(s), under exclusive licence to International Spinal Cord Society 2019

                neurosurgery,quality of life
                neurosurgery, quality of life

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