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Anterior Decompression of the Thoracic Spine through the Posterior Approach:Its usefulness, indications, technique, and the preservation of postoperative spinal stability Tsukasa NISHIURA 1 , Naoshi HAGIHARA 1 , Tetsuya MASAOKA 1 , Ichiro MIYATA 1 , Hiroshi ISHIMITSU 1 , Yasuhiro HARADA 2 1Department of Neurosurgery, Iwakuni National Hospital 2Department of Neurosurgery, Okayama Municipal Hospital Keyword: Thoracic spine , Posterior approach , Anterior decompression , OPLL pp.377-382
Published Date 1994/4/10
DOI https://doi.org/10.11477/mf.1436900826
  • Abstract
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Three patients with thoracic myelopathy were oper-ated on using a modified surgical approach, anterior de-compression of the thoracic cord through the posterior approach. The usefulness of and indication for this approach were discussed.

Operative technique is as follows. In the prone posi-tion, laminae are removed widely enough to include the medial half of the facets and pedicles. This creates cavi-ties lateral to the dural sac as deep as the diameter of the spinal canal. Through these cavities the anterior wall of the spinal canal and the posterior portion of the intervertebral disc are drilled out to make a space into which lesions are pulled away from the dural sac. The lesions can be removed under direct vision with mini-mum retraction to the dural sac. Our technique pre-serves the integrity of the spinous prosesses and supra/ inter spinal ligaments, which do not restrict access to the cord and have the potential to be one of the sup-ports of the spine. Postoperative course was uneventful in all of the patients.

This approach has several advantages. It can be ap-plied to any levels of the thoracic spine and can be used for decompression all around the thoracic cord. The procedure is minimumly invasive. The indications for this operation are considered to be 1) lesions at the level of T3, 2) anterior lesions associated with OYL at the same or adjacent level, 3) multilevel lesions which need staged operations, 4) laterally protruded discs and 5) lesions in elderly or high risk patients.


Copyright © 1994, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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