• Wei Tian, Chong Weng, Bo Liu, Qin Li, Yu-Qing Sun, Qiang Yuan, Bo Zhang, Yong-Qing Wang, and Da He.
• Department of Spine Surgery, Peking University Fourth Clinical Medical College, Beijing Jishuitan Hospital, Beijing, PR China. orthdanielcw@yahoo.com
• J Spinal Disord Tech. 2013 Aug 1; 26 (6): E227-34.

Study DesignA retrospective clinical study was conducted.ObjectiveThe purpose of this study was to describe the clinical outcomes of intraoperative 3D navigation (ITN) and ultrasonography during posterior decompression and instrumented fusion for thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL).Summary Of Background DataThe symptoms caused by thoracic-ossification of the posterior longitudinal ligament (T-OPLL) are usually progressive and do not respond to conservative treatment-surgical intervention is the only effective treatment option. Various methods have been described for the treatment of symptomatic T-OPLL, all of which have limitations.MethodsThe study included 18 patients with T-OPLL who underwent posterior decompression with instrumented fusion from 2006 to 2011. A staged operative procedure was used. First, pedicle screws were placed with ITN and a wide laminectomy was performed with resection of ossification of the ligamentum flavum (if present). With insufficient decompression on intraoperative ultrasonography, additional circumferential decompression was performed through a transpedicular approach. ITN-guided OPLL resection was performed using a burr attached to a navigational tracker. In all cases, posterior instrumented fusion was performed in situ. The outcomes were evaluated with the modified Japanese Orthopaedic Association scores and recovery rates.ResultsIntraoperative ultrasonography showed that posterior laminectomy was sufficient in 6 patients; the remaining 12 were treated with additional circumferential decompression. The follow-up period ranged from 1 to 6 years (mean period, 2.8 y). Postoperative transient neurological deterioration occurred in 1 patient, and cerebrospinal fluid leakage occurred in 4 patients. All patients showed neurological recovery with a mean Japanese Orthopaedic Association score that improved from 5.5 points preoperatively to 8.5 points at the final follow-up and a mean recovery rate of 54.5%.ConclusionsIntraoperative ultrasonography and ITN are safe and reliable imaging methods for posterior decompression and instrumented fusion for thoracic myelopathy caused by OPLL.

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