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

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          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.


          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 references 15

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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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            Thoracic myelopathy secondary to ossification of the spinal ligament.

             Luis Ono,  S Ebara,  D S Ojima (1987)
            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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              Circumspinal decompression with dekyphosis stabilization for thoracic myelopathy due to ossification of the posterior longitudinal ligament.

              Circumspinal decompression with dekyphosis stabilization was prospectively performed with thoracic myelopathy due to ossification of posterior longitudinal ligament (OPLL). Neurologic outcome was reviewed.

                Author and article information

                +91-9597732908 , kalyanvarmambbs@gmail.com
                Spinal Cord Ser Cases
                Spinal Cord Ser Cases
                Spinal Cord Series and Cases
                Nature Publishing Group UK (London )
                22 August 2019
                : 5
                ISNI 0000 0004 1800 5096, GRID grid.464889.f, Indian Spinal Injuries Center, Vasant Kunj, ; New Delhi, 110070 India
                © International Spinal Cord Society 2019
                Case Report
                Custom metadata
                © The Author(s), under exclusive licence to International Spinal Cord Society 2019

                quality of life, neurosurgery


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