Objective To explore short-term effectiveness of floating island laminectomy surgery in treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum. Methods A total of 31 patients with thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum between January 2019 and April 2022 were managed with floating island laminectomy surgery. The patients comprised 17 males and 14 females, aged between 36 and 78 years, with an average of 55.9 years. The duration of symptoms of spinal cord compression ranged from 3 to 62 months (mean, 27.2 months). The lesions affected T1-6 in 4 cases and T7-12 in 27 cases. The preoperative neurological function score from the modified Japanese Orthopaedic Association (mJOA) was 4.7±0.6. Surgical duration, intraoperative blood loss, and complications were recorded. The thoracic MRI was conducted to reassess the degree of spinal cord compression and decompression after operation. The mJOA score was employed to evaluate the neurological function and calculate the recovery rate at 12 months after operation. Results The surgical duration ranged from 122 to 325 minutes, with an average of 204.5 minutes. The intraoperative blood loss ranged from 150 to 800 mL (mean, 404.8 mL). All incisions healed by first intention after operation. All patients were followed up 12-14 months, with an average of 12.5 months. The patients’ symptoms, including lower limb weakness, gait disorders, and pain, significantly improved. The mJOA scores after operation significantly increased when compared with preoperative scores (P<0.05), gradually improving with time, with significant differences observed among 1, 3, and 6 months (P<0.05). The recovery rate at 12 months was 69.76%±11.38%, with 10 cases exhibiting excellent neurological function and 21 cases showing good. During the procedure, there were 3 cases of dural tear and 1 case of dural defect. Postoperatively, there were 2 cases of cerebrospinal fluid leakage. No aggravated nerve damage, recurrence of ligamentum flavum ossification, or postoperative thoracic deformity occurred. ConclusionThe floating island laminectomy surgery is safe for treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum, effectively preventing the exacerbation of neurological symptoms. Early improvement and recovery of neurological function are achieved.
目的：对平山病的临床特点、电生理、影像学、预后以及发病机制进行分析。方法：以“平山病”或“上肢肌萎缩”为主题词，以中国数字期刊总库和中华医学会数字化期刊为数据库，共检索167篇文献，剔除重复报道以及病例资料不全的文献，对22篇国内杂志发表及我院诊治的病例共192例患者的临床资料进行分析。结果：192例患者，男∶女=6.7∶1，起病年龄平均18.6岁。隐匿起病，表现多以一侧上肢远端肌肉无力伴肌萎缩，右侧多见，77.6%患者有伸指颤动，81.3%有寒冷麻痹。全部患者患肢肌电图运动单位电位时限延长，95.8%对侧上肢远端肌电图出现类似的改变。颈部自然位MRI 44.3%发现低位颈髓萎缩，屈曲位均发现颈髓前移，硬脊膜后壁前移，硬脊膜外间歇增宽。病情在3~4年后处于稳定状态，部分患者经颈托治疗病情好转。结论：平山病是一种少见的良性自限性疾病，好发于青少年，主要表现上肢远端不对称肌萎缩，早期佩戴颈托可以阻止病情进展。
Twenty cases of myelopathy secondary to cervical spondylosis had been treated by anterior expansive decompression and interbody iliac bone graft. Follow-up for 8 to 42 months, the therapeutic results were satisfactory without any obvious complications. The techniques of fenestration and bone graft were introduced. The advantages of this operation were discussed.