Lamina-Lifting Suspension Modification in Bridge Crane Technique in Treatment of Severe Thoracic Ossification of the Ligamentum Flavum (TOLF)

Med Sci Monit, 2023 · DOI: 10.12659/MSM.941803 · Published: December 15, 2023

Simple Explanation

This study introduces a novel surgical technique combining a lamina-lifting suspension system with the bridge crane technique to treat thoracic ossification of the ligamentum flavum (TOLF), a condition where spinal ligaments turn into bone, causing spinal cord compression and neurological issues. The technique involves implanting internal fixation, separating laminae, installing cross-bridges, reverse lifting, and fixation of cross-bridges to decompress the spinal cord without direct intervention within the spinal canal, aiming to reduce surgical risks and postoperative complications. The results showed significant improvement in the patient's lower limb function and spinal cord status, with no observed adverse effects, suggesting the technique's potential effectiveness and safety in treating severe TOLF.

Study Duration

1 year follow-up

Participants

1 patient with severe thoracic myelopathy

Evidence Level

Level IV, Case Study

Key Findings

1
The surgical intervention significantly enhanced the patient’s lower limb function, as evidenced by an increase in mJOA score from 5 preoperatively to 11 at terminal follow-up.
2
Imaging data showed that the ossification of the thoracic vertebrae had subsided, while the volume of the local spinal canal had recovered and the spinal cord injury had been completely relieved.
3
The postoperative Hirabayashi recovery rate was 25-50%, resulting in complete resolution of the lower limb disfunction.

Research Summary

The study investigated the effectiveness of a lamina-lifting suspension system combined with the bridge crane technique for treating thoracic ossification of the ligamentum flavum (TOLF) with myelopathy. The surgical procedure involved a series of steps aimed at decompressing the spinal cord and stabilizing the spine, resulting in significant improvements in the patient's neurological function and spinal canal volume. The authors conclude that the lamina-lifting suspension system enhances the benefits of the bridge crane technique, making it a safer and more manageable approach for treating TOLF, although further research is needed.

Practical Implications

Improved Surgical Technique

The lamina-lifting suspension system offers a more controlled and stable decompression process compared to traditional methods, potentially reducing surgical complications.

Enhanced Patient Outcomes

The study demonstrates the potential for significant improvement in neurological function and spinal cord status in patients with severe TOLF.

Reduced Risk of CSF Leakage

By avoiding direct manipulation of the dura mater, the technique may lower the risk of cerebrospinal fluid (CSF) leakage, a common complication in spinal surgeries.

Study Limitations

1
This study only reported 1 case, so additional sample analysis and research are required
2
This technique is only applicable to the thoracic vertebrae from neutral to the lordotic segment, and the effect on the kyphotic spine may be limited due to the risk of insufficient spinal cord floating
3
During the procedure, incomplete removal of the posterior lamina hindered the surgeon’s ability to observe the effects of spinal decompression and intraspinal hemostasis

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