Objective To investigate the surgery tactics for ossification of ligamentum flavum (OLF) associated with dural ossification (DO) in the thoracic spine and the cl inical outcome. Methods Between June 2006 and December 2009, 98 patients with thoracic spinal stenosis secondary to OLF were treated, and DO was found in 18 cases during operation. There were 11 males and 7 females with a mean age of 58 years (range, 46-73 years). The disease duration ranged from 5 to 48 months (mean,20 months). All patients underwent surgical decompression because of recent neurological aggravation. Both DO and OLF were resected with octagonal decompression by dissecting pedicle flavum tunnel. The Japanese Orthopaedic Association (JOA) score, modified Oswestry Disabil ity Index (ODI), and the Cobb angle were used to evaluate the effectiveness. Results The initial symptoms were significantly alleviated postoperatively. All patients had transient cerebrospinal fluid (CSF) leakage postoperatively, the CSF leakage disappeared after 8-10 days of conservative treatment. All the incisions healed by first intention. There was no complication of neurologic function deterioration, meningitis, wound infection, or spinocutaneous fistula. Eighteen patients were followed up 20-60 months (mean, 49 months). No recurrence of spinal cord compression symptoms,or neurologic function deterioration was observed at last follow-up. The JOA scores and effectiveness and modified ODI scores were significantly improved after 1 month and 12 months of operation when compared with preoperative scores (P lt; 0.05). The Cobb angles of kyphosis of the involved vertebrae were (6.7 ± 1.6)° before operation and (8.0 ± 1.2)° after 12 months of operation, showing significant difference (t=4.000，P=0.001). Postoperative T2-weighted axial MRI, sagittal MRI scan, and short T1 inversion recovery MRI showed that compressed deformity of the spinal cord returned to normal. Conclusion The surgery tactics for thoracic spinal stenosis secondary to the OLF with DO is safe, and no patching dura mater tears is effective.
Objective To investigate the therapeutic effect of artificial dura mater on the prevention and treatment of cerebrospinal fluid (CSF) leakage associated with thoracolumbar fracture and dislocation. Methods A total of 58 patients with thoracolumbar fracture and dislocation combined with dura mater injury and CSF leakage were treated in Affiliated Hospital of Southwest Medical University from January 2011 to December 2016, including 30 males and 28 females, aged from 15 to 86 years, with an average of (51.8±16.3) years. All patients were treated with posterior pedicle screw system for decompression, reduction fixation and fusion, dura mater and spinal cord injury were investigated, and external nerve roots or caudate nerves were exposed. At the same time; the dura mater was sutured and repaired and partially covered with gelatinous sponge (group A, 24 cases), or after dura mater was sutured and repaired, the artificial dura mater was partially covered (group B, 34 cases). The curative effect and complications of the two different treatment methods were evaluated. Results All operations were successfully completed. The operative time was 110–340 minutes, with an average of (195.0±10.4) minutes; the intraoperative blood loss was 200–2 800 mL, with an average of (845.0±26.5) mL. In group A, 13 patients (54.1%) acquired wound healing, and the average CSF leakage duration was (13.4±1.6) days postoperatively, among whom 3 cases were complicated with pseudomeningocele; 11 cases (45.9%) failed and necessitated additional management. Among the 11 cases, 6 case had no decreasing tendency of CSF leakage after 10-day drainage, and after subarachnoid drainage was performed, CSF leakage disappeared about 15 days after operation; 3 (12.5%) with wound infection underwent operative incision debridement, after the repair of the dura sac, the subarachnoid CSF was drainage at the lumbar part combined with the systemic situation with antibiotics and other symptomatic treatment, and the patients were cured about 16 days after the operation; 2 (8.3%) with spinal meningitis underwent subarachnoid CSF drainage and administration of antibiotics, and the CSF leakage ceased about 14 days after operation. In group B, 27 patients (79.4%) acquired wound healing, and the average CSF leakage duration was (9.1±1.7) days postoperatively; among whom, 4 cases were complicated with pseudomeningocele; 7 cases (20.6%) failed and necessitated additional management. Among the 7 cases, 5 cases had no decreasing tendency of CSF leakage after 10-day drainage, and CSF leakage disappeared around 12 days after treatment; 1 case (2.9%) with wound infection and 1 case (2.9%) with spinal meningitis, both were cured after the treatment as in group A. Conclusion Dural suture repair combined with artificial dura mater mulch repair can more effectively repair the dura tears associated with thoracolumbar vertebral fracture dislocation and reduce the incidence of CSF leakage.