Minim Invasive Neurosurg 2010; 53(3): 138-141
DOI: 10.1055/s-0030-1249703
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Video-Assisted Thoracoscopic Removal of Ossified Posterior Longitudinal Ligament (OPLL) in the Thoracic Spine: A Case Report

J. S. Kim1 , S. H. Lee1 , J. Y. Seong1 , K. H. Kim2 , B. Jung1
  • 1Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Republic of Korea
  • 2Department of Orthopaedic Surgery, Wooridul Spine Hospital, Seoul, Republic of Korea
Further Information

Publication History

Publication Date:
31 August 2010 (online)

Abstract

Background: When the transthoracic approach is used for the treatment of a thoracic ossified posterior longitudinal ligament (OPLL), there could be a lot of operative risks, morbidity, and mortality for the patient.

Case Report: A 65-year-old female manifested back pain and tingling sensations in both legs due to OPLL at the T6-7 level. A thoracoscopic procedure was performed to remove the OPLL, achieving complete decompression of thoracic cord. The symptoms were relieved and the patient was discharged on the sixth day after the operation.

Conclusions: A minimally invasive procedure using the thoracoscopic technique could be a good alternative option in selected cases when a conventional transthoracic approach is impossible due to the patient’s general condition.

References

  • 1 Fujimura Y, Nishi Y, Nakamura M. et al . Anterior decompression and fusion for ossification of the posterior longitudinal ligament of the upper thoracic spine causing myelopathy: using the manubrium splitting approach.  Spinal Cord. 1996;  34 387-393
  • 2 Fujimura Y, Nishi Y, Nakamura M. et al . Myelopathy secondary to ossification of the posterior longitudinal ligament of the thoracic spine treated by anterior decompression and bony fusion.  Spinal Cord. 1997;  35 777-784
  • 3 Ido K, Shimizu K, Iida H. et al . Surgical treatment for ossification of the posterior longitudinal ligament and the yellow ligament in the thoracic and cervico-thoracic spine.  Spinal Cord. 1998;  36 561-566
  • 4 Ido K, Shimizu K, Nakayama Y. et al . Anterior decompression and fusion for ossification of posterior longitudinal ligament in the thoracic spine.  J Spinal Disord. 1995;  8 317-323
  • 5 Kojima T, Waga S, Kubo Y. et al . Surgical treatment of ossification of the posterior longitudinal ligament in the thoracic spine.  Neurosurgery. 1994;  34 854-858 discussion 858
  • 6 Komagata M, Inahata Y, Nishiyama M. et al . Treatment of myelopathy due to cervicothoracic opll via open door laminoplasty.  J Spinal Disord Tech. 2007;  20 342-346
  • 7 Nakanishi K, Tanaka N, Nishikawa K. et al . Positive effect of posterior instrumentation after surgical posterior decompression for extensive cervicothoracic ossification of the posterior longitudinal ligament.  Spine. 2005;  30 E382-E386
  • 8 Tokuhashi Y, Matsuzaki H, Oda H. et al . Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine: usefulness of the ossification-kyphosis angle on MRI.  Spine. 2006;  31 E26-E30
  • 9 Yamazaki M, Mochizuki M, Ikeda Y. et al . Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion.  Spine. 2006;  31 1452-1460
  • 10 Min JH, Jang JS, Lee SH. Significance of the double- and single-layer signs in the ossification of the posterior longitudinal ligament of the thoracic spine.  Neurosurgery. 2007;  61 118-121 discussion 121–122
  • 11 Tomita K. Total decompression of the spinal cord for combined ossification of posterior longitudinal ligament and yellow ligament in the thoracic spine.  Arch Orthop Trauma Surg. 1990;  109 57-62
  • 12 Tomita K, Kawahara N, Baba H. et al . Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and ligamentum flavum.  Spine. 1990;  15 1114-1120
  • 13 Epstein NE. Identification of ossification of the posterior longitudinal ligament extending through the dura on preoperative computed tomographic examinations of the cervical spine.  Spine. 2001;  26 182-186
  • 14 Hioki A, Miyamoto K, Hosoe H. et al . Two-staged decompression for thoracic paraparesis due to the combined ossification of the posterior longitudinal ligament and the ligamentum flavum: a case report.  Arch Orthop Trauma Surg. 2008;  128 175-177
  • 15 Matsuyama Y, Yoshihara H, Tsuji T. et al . Surgical outcome of ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine: implication of the type of ossification and surgical options.  J Spinal Disord Tech. 2005;  18 492-497 discussion 498
  • 16 Bühren V. Thoracoscopic management of fractures of the thoracic and lumbar spine.  Langenbecks Arch Chir Suppl Kongressbd. 1998;  115 108-112
  • 17 Huang TJ, Hsu RW, Chen SH. et al . Video-assisted thoracoscopic surgery in managing tuberculous spondylitis.  Clin Orthop Relat Res. 2000;  379 143-153
  • 18 Huang TJ, Hsu RW, Chen YJ. Minimal-access surgery in managing osteoporotic vertebral fractures with neurological deficits: a preliminary report.  Chang Gung Med J. 2000;  23 542-549
  • 19 Huang TJ, Hsu RW, Liu HP. et al . Analysis of techniques for video-assisted thoracoscopic internal fixation of the spine.  Arch Orthop Trauma Surg. 1998;  117 92-95
  • 20 Ishikawa E, Matsumura A, Ishikawa S. et al . Combined minimally invasive approach using microsurgery and thoracoscopic surgery for resecting a dumbbell-type thoracic schwannoma.  Minim Invas Neurosurg. 2002;  45 251-253
  • 21 Oskouian Jr RJ, Johnson JP, Regan JJ. Thoracoscopic microdiscectomy.  Neurosurgery. 2002;  50 103-109
  • 22 Rosenthal D. Endoscopic approaches to the thoracic spine.  Eur Spine J. 2000;  9 ((Suppl.1)) S8-S16 [Review]
  • 23 Beisse R, Mückley T, Schmidt MH. et al . Surgical technique and results of endoscopic anterior spinal canal decompression.  J Neurosurg Spine. 2005;  2 128-136

Correspondence

B. JungMD, PhD 

Department of Neurosurgery

Wooridul Spine Hospital

47-4 Chungdam-dong

Gangnam-gu

Seoul 135-100

Korea

Phone: +82/2/513 8150

Fax: +82/2/513 8146

Email: if2000@wooridul.co.kr

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