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Original Articles

Minimally Invasive Surgery

Biportal Endoscopic Techniques for Severe Dural Ossification in Thoracic Ossification of the Ligamentum Flavum: Insights From Preoperative Imaging
Ji Yeon Kim, Su Yong Choi, Dong Chan Lee, Hyeun Sung Kim, Dong Hwa Heo
Neurospine 2025;22(3):819-828.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550338.169

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Biportal Endoscopic Techniques for Severe Dural Ossification in Thoracic Ossification of the Ligamentum Flavum: Insights From Preoperative Imaging
Neurospine. 2025;22(3):819-828.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550338.169
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Biportal Endoscopic Techniques for Severe Dural Ossification in Thoracic Ossification of the Ligamentum Flavum: Insights From Preoperative Imaging
Neurospine. 2025;22(3):819-828.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550338.169
Close
Objective
This study evaluates surgical strategies based on preoperative computed tomography (CT) findings during unilateral biportal endoscopic (UBE) surgery for thoracic ossification of the ligamentum flavum (OLF) with dural ossification.
Methods
This retrospective study included patients undergoing posterior thoracic laminectomy via UBE surgery to treat symptomatic thoracic stenosis due to OLF. Clinical outcomes were assessed using visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) scores, alongside analyses of preoperative CT and intraoperative videos for dural ossification characteristics.
Results
A total of 34 patients participated, showing significant improvements in VAS and JOA scores postoperatively. All focal dural ossifications exhibiting the tram-track sign were effectively excised without significant dural defects. The circumferential floating technique was employed for cases with the bridge sign, whereas wide excision was warranted for those with the comma sign.
Conclusion
UBE surgery effectively manages progressive thoracic OLF associated with dural ossification. Preoperative CT imaging is essential for assessing dural involvement and guiding surgical techniques. Microscopic surgery is recommended for inexperienced surgeons requiring wide dural excision.

Citations

Citations to this article as recorded by  Crossref logo
  • The Safety and Efficacy of Unilateral Biportal Endoscopic Decompression for the Treatment of Thoracic Ossification of Ligamentum Flavum with Occupancy Ratio > 60%: A Retrospective Cohort Study
    Lei Qi, Biteng Xu, Xiangji Guo, Gaoya Yu, Yuxuan Yang, Haozhi Yu, Liang Wang
    Pain and Therapy.2026; 15(1): 379.     CrossRef
  • Biportal endoscopic spinal surgery for thoracic ossification of the ligamentum flavum: a study of different classification types and surgical outcomes
    Honggang Wang, Dongqing He, Ruxing Liu, Jie Yuan, Yongfeng Wang
    Frontiers in Neurology.2026;[Epub]     CrossRef
  • Radiologic and clinical outcomes of unilateral biportal endoscopic decompression for thoracic ossification of the ligamentum flavum
    Sang-Woo Lee, JinWoo Jung, Sang-Kyu Son, Man-Kyu Park
    European Spine Journal.2026;[Epub]     CrossRef
  • 7,627 View
  • 102 Download
  • 3 Web of Science
  • 3 Crossref

Deformity

Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis
Xi Lin, Satoshi Suzuki, Kazuki Takeda, Takahito Iga, Toshiki Okubo, Masahiro Ozaki, Osahiko Tsuji, Narihito Nagoshi, Morio Matsumoto, Masaya Nakamura, Kota Watanabe
Neurospine 2025;22(2):354-363.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2449254.627

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Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis
Neurospine. 2025;22(2):354-363.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2449254.627
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Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis
Neurospine. 2025;22(2):354-363.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2449254.627
Close
Objective
To examine the factors influencing cervical sagittal alignment (CSA) after posterior correction and fusion surgery (PSF) for patients with Lenke type 2 adolescent idiopathic scoliosis (AIS).
Methods
A total of 102 female patients with Lenke 2 AIS and a minimum 2-year follow-up were included. The upper instrumented vertebra was T2 in all patients. Sagittal and coronal parameters were measured before and 2 years after surgery. Patients were categorized into cervical malalignment (CM) and noncervical malalignment (NCM) groups following Passias’ criteria. Radiographic factors influencing CSA were analyzed.
Results
Preoperatively, 57 patients (55.9%) were assigned to the CM group and 45 patients (44.1%) to the NCM groups. The cervical lordosis (CL) in CM group was more kyphotic (19.3° vs. 3.3°), smaller proximal thoracic kyphosis (PTK; 9.7° vs. 15.4°), and smaller T1 slope (7.1° vs. 14.0°) than those in the NCM group. Main thoracic kyphosis (MTK) did not show significantly difference between the 2 groups (11.3° vs. 14.4°). Two years after surgery, the CM group demonstrated significant improvements in CSA. PTK increased from 9.7° to 13.5°, T1 slope increased from 7.1° to 10.5°, and cervical kyphosis improved from -19.3° to -8.8°, while MTK remained unchanged (11.3° vs. 11.6°).
Conclusion
PSF significantly improved CSA in patients with preoperative CM. Increased PTK, correlated with improved CL, suggests that PSF-induced PTK enhancement, rather than MTK, drives T1 slope and subsequent CSA improvement.

Citations

Citations to this article as recorded by  Crossref logo
  • In Correction Surgery for Adolescent Idiopathic Scoliosis with Lenke Type 1 and 2 curves, Obtaining Kyphosis in the Upper Thoracic Spine Is Important for Preventing Postoperative Cervical Kyphosis
    Kanji Mori, Jun Takahashi, Hiroki Oba, Shinji Sasao, Shota Ikegami, Tetsuhiko Mimura, Shinji Imai
    Spine Surgery and Related Research.2026; 10(1): 89.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the June 2025 Issue
    Inbo Han
    Neurospine.2025; 22(2): 309.     CrossRef
  • A Commentary on “Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis”
    Seung Woo Suh
    Neurospine.2025; 22(2): 364.     CrossRef
  • 3,699 View
  • 67 Download
  • 3 Crossref

Video Article

Video Articles: Special Issue With JMISST

Uniportal Full Endoscopic 270° Decompression for Thoracic 1–2 Hard Disc Herniation With Ossification of the Ligamentum Flavum
Hyun-Jin Ma, Sang Ho Lee, Chan Hong Park
Neurospine 2024;21(4):1108-1115.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2449044.522

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Uniportal Full Endoscopic 270° Decompression for Thoracic 1–2 Hard Disc Herniation With Ossification of the Ligamentum Flavum
Neurospine. 2024;21(4):1108-1115.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2449044.522
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Uniportal Full Endoscopic 270° Decompression for Thoracic 1–2 Hard Disc Herniation With Ossification of the Ligamentum Flavum
Neurospine. 2024;21(4):1108-1115.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2449044.522
Close
This article aims to demonstrate the uniportal full endoscopic surgery for treating complex anterior and posterior spinal pathology at the T1–2 level, offering a invasive, accessible, stable, and versatile approach to challenging anatomical situations. Uniportal full endoscopic surgery is one of the most minimally invasive spinal surgeries, utilizing slim, elongated, and compact instruments that provide access to lesions from any angle and distance. This characteristic makes the technique especially suitable for hard, such as the T1–2 level, where traditional approaches may be limited or difficult. We present the case of a 39-year-old male patient (height, 187 cm; weight, 130 kg) who developed myelopathy due to a hard disc herniation and ossification of the ligamentum flavum at the T1–2 leading to paraparesis, which was more severe on the left side. An anterior approach was challenging due to the anatomical constraints at the T1–2 level, as well as the patient’s body size. A posterior access via the interlaminar approach facilitated the removal of the ossified ligamentum flavum. However, to the anterior lesion remained problematic without spinal cord retraction. Using the uniportal full endoscope, we were able to approach both anterior and posterior lesions through an incision 8 cm lateral to the midline, allowing for the treatment of the entire 270° arc of the pathology. The slim and elongated nature of the full endoscope enabled effective decompression without exerting pressure on the spinal cord, providing access from any angle and distance. This technique can be applied to a variety of cases involving difficult-to-access spinal.

Citations

Citations to this article as recorded by  Crossref logo
  • Treatment of Calcified Thoracic Disc Herniation by Percutaneous Spinal Endoscopy with Culvert Decompression
    Donglun Xiao, Yuefei Li, Ning Sun, Xin Liu, Rui Li, Tianwei Sun
    World Neurosurgery.2026; 206: 124763.     CrossRef
  • 4,530 View
  • 87 Download
  • 1 Web of Science
  • 1 Crossref

Original Articles

Regular Issue

Comparison of Clinical Outcomes of Posterior-Only Transforaminal Debridement and Interbody Fusion With Preservation of Posterior Ligamentous Complex Versus Conventional Posterior-Only Debridement and Interbody Fusion for Thoracic Spine Tuberculosis: A Prospective, Randomized, Controlled, Clinical Trial - A Pilot Study
Yuxiang Wang, Shuntian Xiao, Guohui Zeng, Hongqi Zhang, Emmanuel Alonge, Zhuocheng Yang
Neurospine 2024;21(3):954-965.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448356.178

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Comparison of Clinical Outcomes of Posterior-Only Transforaminal Debridement and Interbody Fusion With Preservation of Posterior Ligamentous Complex Versus Conventional Posterior-Only Debridement and Interbody Fusion for Thoracic Spine Tuberculosis: A Prospective, Randomized, Controlled, Clinical Trial - A Pilot Study
Neurospine. 2024;21(3):954-965.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448356.178
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Comparison of Clinical Outcomes of Posterior-Only Transforaminal Debridement and Interbody Fusion With Preservation of Posterior Ligamentous Complex Versus Conventional Posterior-Only Debridement and Interbody Fusion for Thoracic Spine Tuberculosis: A Prospective, Randomized, Controlled, Clinical Trial - A Pilot Study
Neurospine. 2024;21(3):954-965.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448356.178
Close
Objective
The main objective of this study was to analyze the efficacy and feasibility of surgical management for patients with thoracic spinal tuberculous spondylitis (STB) by using posterior-only transforaminal debridement and interbody fusion (PTDIF) with preservation of posterior ligamentous complex (PLC) and noninferior of PTDIF compared with conventional posterior-only debridement and interbody fusion (CPDIF).
Methods
From January 2019 to January 2022, a prospective, randomized, controlled trial was conducted in which patients with thoracic STB were enrolled and assigned to undergo either the PTDIF group (group A) or CPDIF group (group B) in a 1:1 ratio. The clinical efficacy was evaluated on average operation time, blood loss, hospitalization durations, visual analogue scale, Oswestry Disability Index scores, erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), and neurological function recovery using the American Spinal Injury Association’s impairment scale and operative complications. Radiological measurements included kyphosis correction, loss of correction. The outcomes were compared between the groups at preoperation, postoperaion, and final follow-up.
Results
All 65 patients were completely cured during the follow-up. The intraoperative blood loss and operation time in group B were more than that in group A. All patients were pain-free at the final follow-up visit. ESR, CRP returned to normal limits in all patients 3 months after surgery. All patients had improved neurological signs. No significant difference was found in kyphosis angle correction, loss of correction between the 2 groups.
Conclusion
PTDIF, with preservation of PLC, achieved debridement, decompression, and reconstruction of the spine’s stability, similar to CPDIF in the surgical treatment of thoracic STB. PTDIF has less surgical trauma with less intraoperative blood loss and operation time.

Citations

Citations to this article as recorded by  Crossref logo
  • Comparative Clinical Efficacy and Safety of Multi‐Segment Thoracolumbar Tuberculosis Treated Through the Posterior “Detour Method” Versus the Combined Anterior–Posterior Approach: A Technique Note and Preliminary Retrospective Study
    Dian Zhong, Wei Zeng, Guosheng Zhao, Yu Du, Yang Wang, Zhenyong Ke
    Orthopaedic Surgery.2026; 18(7): 1508.     CrossRef
  • From single ligament to multi-ligament injury: a finite element study on the contribution of the posterior ligamentous complex to segmental stability and intervertebral disc stress distribution
    Jingbo Ma, Yu Ding, Rigbat Rozi, Jiaheng Han, Qiang Jiang
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
  • 5,322 View
  • 116 Download
  • 2 Web of Science
  • 2 Crossref

NASS/Neurospine Endoscopic Spine Surgery Special Issue

Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
Ji Yeon Kim, Ji Soo Ha, Chang Kyu Lee, Dong Chan Lee, Hyun Jin Hong, Su Yong Choi, Choon Keun Park
Neurospine 2023;20(1):129-140.   Published online March 31, 2023
DOI: https://doi.org/10.14245/ns.2346060.030

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Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
Neurospine. 2023;20(1):129-140.   Published online March 31, 2023
DOI: https://doi.org/10.14245/ns.2346060.030
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Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
Neurospine. 2023;20(1):129-140.   Published online March 31, 2023
DOI: https://doi.org/10.14245/ns.2346060.030
Close
Objective
Advanced biportal endoscopic surgery techniques can be used to treat thoracic myelopathy secondary to ossification of the ligamentum flavum (OLF). This case series elaborates on a feasible biportal endoscopic technique for thoracic OLF removal and evaluates clinical and radiological outcomes.
Methods
A biportal endoscopic posterior thoracic laminectomy was performed to remove the thoracic OLF. Surgical techniques have evolved from inside-out piecemeal removal methods to outside-in en bloc removal methods. Preoperative computed tomography was performed to analyze dural ossification and OLF types. Intraoperative videos were reviewed to observe dural ossification and to determine the surgical method. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) score.
Results
Clinical symptoms and neurological function improved markedly after surgery (JOA score, preoperative: 12.6 ± 1.0, final follow-up: 15.6 ± 1.2). The mean operation time per segment was not short (106.6 ± 38 minutes). At early experience stages, inside-out piecemeal decompression was used and it caused intraoperative spinal cord injury. However, outside-in en bloc decompression technique did not induce neural complications. Postoperative segmental instability and correlated mechanical back pain were not observed.
Conclusion
The biportal endoscopic posterior thoracic approach is an attractive surgical option to treat thoracic spondylotic myelopathy secondary to OLF. Piecemeal inside-out decompression can induce irreversible spinal cord injury, especially in the early experience stages. Outside-in decompression is more efficient and safer than inside-out pattern procedures by minimizing dural manipulation. Nonetheless, this technique is technically demanding and should only be performed in selected patients after acquiring abundant experience with endoscopic spine surgeries.

Citations

Citations to this article as recorded by  Crossref logo
  • Unilateral biportal endoscopy (UBE) spine surgery for thoracolumbar intervertebral disc diseases in dogs: An ex vivo cadaveric and in vivo preclinical study
    Sanghyun Nam, Youngjin Jeon, Jueun Kim, Jaemin Jeong, Seongmok Jeong, Youngwon Lee, Haebeom Lee
    Veterinary Surgery.2026; 55(4): 816.     CrossRef
  • The Safety and Efficacy of Unilateral Biportal Endoscopic Decompression for the Treatment of Thoracic Ossification of Ligamentum Flavum with Occupancy Ratio > 60%: A Retrospective Cohort Study
    Lei Qi, Biteng Xu, Xiangji Guo, Gaoya Yu, Yuxuan Yang, Haozhi Yu, Liang Wang
    Pain and Therapy.2026; 15(1): 379.     CrossRef
  • A morphometric analysis of thoracic laminae using 3D reconstruction for guiding unilateral biportal endoscopic surgery
    Yuchen Hua, Gangjun You, Pengcheng Lu, Jiahui Su, Shuai Wang, Zenan Zhang, Zhengfeng Dai, Yubin Liu, Benchao Shi
    European Spine Journal.2026;[Epub]     CrossRef
  • Primary Non-Germinal Center-Type Large B-Cell Lymphoma Involving the Thoracic Epidural Space, Cauda Equina, and Filum Terminal: Diagnosis and Treatment Using Biportal Endoscopic Spine Surgery—A Case Report and Literature Review
    Nan-Fu Chen, Chien-Yu Ou
    Reports.2026; 9(1): 61.     CrossRef
  • Biportal endoscopic spinal surgery for thoracic ossification of the ligamentum flavum: a study of different classification types and surgical outcomes
    Honggang Wang, Dongqing He, Ruxing Liu, Jie Yuan, Yongfeng Wang
    Frontiers in Neurology.2026;[Epub]     CrossRef
  • Radiologic and clinical outcomes of unilateral biportal endoscopic decompression for thoracic ossification of the ligamentum flavum
    Sang-Woo Lee, JinWoo Jung, Sang-Kyu Son, Man-Kyu Park
    European Spine Journal.2026;[Epub]     CrossRef
  • Open posterior approach versus endoscopic approach for thoracic ligamentum flavum ossification: a systematic review and meta-analysis
    Chun-Ru Lin, Sung Huang Laurent Tsai, Ta-Wei Yu, Po-Cheng Lin, Zheng-Da Tsai, Kuo-Hao Lee, Tsai-Sheng Fu, Po-Liang Lai, Tsung-Ting Tsai, Yung-Hsueh Hu
    European Spine Journal.2025; 34(1): 380.     CrossRef
  • O-arm navigation-based transforaminal unilateral biportal endoscopic discectomy for upper lumbar disc herniation: an innovative preliminary study
    Dong Hyun Lee, Choon Keun Park, Jin-Sung Kim, Jin Sub Hwang, Jin Young Lee, Dong-Geun Lee, Jae-Won Jang, Jun Yong Kim, Yong-Eun Cho, Dong Chan Lee
    Asian Spine Journal.2025; 19(2): 194.     CrossRef
  • The unilateral biportal endoscopy journey: proposing a 10-tier difficulty progression framework for unilateral biportal endoscopy
    Xavier Augusto Santander, Elsa González Pérez, Dae-Jung Choi
    Asian Spine Journal.2025; 19(2): 311.     CrossRef
  • The need for long-term studies to validate endoscopic surgery
    Ju Eun Kim
    Asian Spine Journal.2025; 19(2): I.     CrossRef
  • Biportal Endoscopic Spinal Surgery for Posterior Decompression of Thoracic Myelopathy Caused by Single-level Thoracic Ossification of the Ligamentum Flavum
    Zhuolin Zhong, Jingjing Ying, Hongwei Wu, Shaohua Zhang, Mingshuai Ying, Qingfeng Hu
    Spine Surgery and Related Research.2025; 9(3): 321.     CrossRef
  • Full endoscopic decompression of thoracic ossification of the ligamentum flavum
    Seung Hoon Lee, Seung Jin Choi, Joo Han Kim, Eun-Sang Kim, Woo-Keun Kwon
    Journal of Clinical Neuroscience.2025; 140: 111505.     CrossRef
  • Current role and future perspectives of endoscopic spine surgery: a narrative review
    Hyung-Rae Lee
    Journal of the Korean Medical Association.2025; 68(8): 528.     CrossRef
  • Biportal Endoscopic Techniques for Severe Dural Ossification in Thoracic Ossification of the Ligamentum Flavum: Insights From Preoperative Imaging
    Ji Yeon Kim, Su Yong Choi, Dong Chan Lee, Hyeun Sung Kim, Dong Hwa Heo
    Neurospine.2025; 22(3): 819.     CrossRef
  • Thoracic spine endoscopic techniques
    Jian Shen, Daniel K. Park, Albert E. Telfeian
    Seminars in Spine Surgery.2024; 36(1): 101085.     CrossRef
  • Safety and efficacy of one-hole split endoscope technique for surgical treatment of thoracic ossification of the ligamentum flavum
    Qi Sha, Zhengdong Huang, Jinhao Liu, Peng Ge, Yong Zhang, En Song, Zhaozhong Sun, Tenyue Zhu, Cailiang Shen, Jun Qian
    Scientific Reports.2024;[Epub]     CrossRef
  • Biportal endoscopic transforaminal thoracic interbody fusion for the treatment of thoracic myelopathy
    Ji Yeon Kim, Su Yong Choi, Kyoung Mo Kim
    Acta Neurochirurgica.2024;[Epub]     CrossRef
  • Biportal endoscopic cervical open-door laminoplasty to treat cervical spondylotic myelopathy
    Ji Yeon Kim, Dong Hwa Heo
    Acta Neurochirurgica.2024;[Epub]     CrossRef
  • Comparison of endoscopic decompression to open laminectomy in patients with thoracic ossified ligamentum flavum – a systematic review and meta-analysis
    Vishal Kumar, Parth Bansal, Vivek P. Ksheerasagar, Sarvdeep Singh Dhatt
    Neurosurgical Review.2024;[Epub]     CrossRef
  • Advanced Technique of 360° Decompression for Thoracic Spondylotic Myelopathy Using the Biportal Endoscopic Posterior Approach
    Ji Yeon Kim, Kyoung Mo Kim, Su Yong Choi, Dong Hwa Heo, Hyeun Sung Kim, Hyeun Jin Hong, Dong Chan Lee
    Journal of Minimally Invasive Spine Surgery and Technique.2024; 9(2): 102.     CrossRef
  • Unilateral Biportal Endoscopic Decompression for Thoracic Spinal Stenosis Secondary to Ossification of the Ligamentum Flavum
    Cheol Woong Park, Borriwat Santipas
    Journal of Minimally Invasive Spine Surgery and Technique.2024; 9(2): 186.     CrossRef
  • Uniportal Full Endoscopic 270° Decompression for Thoracic 1–2 Hard Disc Herniation With Ossification of the Ligamentum Flavum
    Hyun-Jin Ma, Sang Ho Lee, Chan Hong Park
    Neurospine.2024; 21(4): 1108.     CrossRef
  • Uniportal Thoracic Endoscopic Unilateral Laminotomy with Bilateral Decompression of Thoracic Ossification of Ligamentum Flavum: A Systematic Review of Current Literature
    Pang Hung Wu, Brian Zhao Jie Chin, Hyeun Sung Kim, Seth Ian Sim, Il-Tae Jang
    World Neurosurgery.2023; 178: 340.     CrossRef
  • Complications of Endoscopic Thoracic Spine Surgery: Overview and Complication Avoidance
    Man-Kyu Park, Jeong-Yoon Park, Sang-Kyu Son
    World Neurosurgery.2023; 179: 127.     CrossRef
  • Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression Surgery in Severe Lumbar Stenosis Under Electrophysiological Monitoring-Focused on Full-Visualized Trephine/Osteotome
    Ning-Ning Dou, Hao-lin Wang, Shao-Zhen Hu, Zheng-Nan Huang, Jun Zhong, Shi-Ting Li
    Neurospine.2023; 20(3): 1040.     CrossRef
  • Overview and Prevention of Complications During Biportal Endoscopic Thoracic Spine Surgery
    Man-Kyu Park, Sang-Kyu Son
    Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(2): 165.     CrossRef
  • Future of Endoscopic Spine Surgery: Insights from Cutting-Edge Technology in the Industrial Field
    Woon-Tak Yuh, You-Sang Lee, Il Choi
    Bioengineering.2023; 10(12): 1363.     CrossRef
  • 9,105 View
  • 324 Download
  • 29 Web of Science
  • 27 Crossref
Clinical Outcomes and Prognostic Factors in Patients With Myelopathy Caused by Thoracic Ossification of the Ligamentum Flavum
Jae-Kwang Kim, Hyun-Seung Ryu, Bong Ju Moon, Jung-Kil Lee
Neurospine 2018;15(3):269-276.   Published online September 7, 2018
DOI: https://doi.org/10.14245/ns.1836128.064

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Clinical Outcomes and Prognostic Factors in Patients With Myelopathy Caused by Thoracic Ossification of the Ligamentum Flavum
Neurospine. 2018;15(3):269-276.   Published online September 7, 2018
DOI: https://doi.org/10.14245/ns.1836128.064
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Clinical Outcomes and Prognostic Factors in Patients With Myelopathy Caused by Thoracic Ossification of the Ligamentum Flavum
Neurospine. 2018;15(3):269-276.   Published online September 7, 2018
DOI: https://doi.org/10.14245/ns.1836128.064
Close
Objective
The objective of this study was to investigate the surgical outcomes and prognostic factors for thoracic ossification of the ligamentum flavum (OLF) after decompressive laminectomy, focusing on the quantitative signal intensity ratio (SIR) of preoperative magnetic resonance imaging (MRI) and its prognostic significance.
Methods
We retrospectively reviewed 24 patients who previously underwent total laminectomy to remove OLF from 2010 to 2015. MRI and computed tomography were performed to detect OLF. The SIR between the regions of interest of high signal intensity lesions and the normal cord at the T1–2 disc levels was calculated. We divided patients into 2 groups based on the extent of the modified Japanese Orthopaedic Association (JOA) recovery rate (RR): good (RR ≥ 50%) and poor (RR < 50%).
Results
The mean preoperative and postoperative modified JOA scores for thoracic myelopathy were 6.67 ± 1.73 and 8.63 ± 1.81, respectively (p < 0.001). The preoperative JOA score (7.5 vs. 5.83, p = 0.028), postoperative JOA score (9.83 vs. 7.42, p = 0.000), and SIR (1.16 vs. 1.41, p = 0.009) were significantly different between the good and poor RR groups. A higher preoperative JOA score and lower SIR were associated with a good RR according to the JOA criteria.
Conclusion
The clinical outcomes for thoracic OLF after decompressive laminectomy were favorable. A higher RR was correlated with a lower SIR and higher preoperative modified JOA score. Therefore, a relatively low SIR on MRI and a relatively high preoperative JOA score could be positive prognostic indicators for the JOA RR in patients with thoracic OLF.

Citations

Citations to this article as recorded by  Crossref logo
  • Biportal Endoscopic Spinal Surgery for Posterior Decompression of Thoracic Myelopathy Caused by Single-level Thoracic Ossification of the Ligamentum Flavum
    Zhuolin Zhong, Jingjing Ying, Hongwei Wu, Shaohua Zhang, Mingshuai Ying, Qingfeng Hu
    Spine Surgery and Related Research.2025; 9(3): 321.     CrossRef
  • Fully Endoscopic Decompression in Dorsal Spinal Myelopathy due to Ligamentum Flavum Calcification
    Harshita Debbarma, Lalji Mangukiya, Asheesh Tandon
    Journal of Spinal Surgery.2025; 12(2): 50.     CrossRef
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Case Report

Rosai-Dorfman Disease in Thoracic Spine: A Rare Case of Compression Fracture
Do Young Kim, Ji Hye Park, Dong Ah Shin, Seung Yi, Yoon Ha, Do Heum Yoon, Keung Nyun Kim
Korean J Spine 2014;11(3):198-201.   Published online September 30, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.3.198

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Rosai-Dorfman Disease in Thoracic Spine: A Rare Case of Compression Fracture
Korean J Spine. 2014;11(3):198-201.   Published online September 30, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.3.198
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Rosai-Dorfman Disease in Thoracic Spine: A Rare Case of Compression Fracture
Korean J Spine. 2014;11(3):198-201.   Published online September 30, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.3.198
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Sinus histiocytosis with massive lymphadenopathy known as Rosai-Dorfman disease is characterized by painless bilateral cervical lymphadenopathy. Extranodal manifestations are uncommon and spinal involvement is rare. A 15-year-old man presented with intermittent midthoracic back pain only. He had no specific findings on neurologic examinations, hematologic and biochemical laboratory tests. Radiological examination of thoracic spine revealed collapse of T6 vertebrae with thoracic kyphosis and osteolytic lesion of T12 vertebra body. He underwent a removal of bone tumor, anterior reconstruction with mesh and pedicle screw fixation via posterior approach for pathologic confirmation and stabilization. Histopathologic study of the lesion revealed focal infiltration of large histiocytes showing emperipolesis. Immunochemistry stain of histiocytes was positive for CD68 and S-100 but negative for CD1a. This report presents a rare case and literature review of extranodal Rosai-dorfman disease in thoracic spine.

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  • Diagnosis and Management of Extranodal Rosai-Dorfman Disease Isolated to the Thoracic Spine: Systematic Review and Illustrative Case
    Rithvik Ramesh, Robert C. Osorio, Melike Pekmezci, Lauren Boreta, Debajyoti Datta, Nima Alan
    World Neurosurgery.2026; 212: 125082.     CrossRef
  • Isolated Rosai-Dorfman disease of the spine: A systematic literature review
    Maroua Slouma, Sirine Bouzid, Karima Tlili, Dahmani Yedaes, Khaled Radhwen, Imen Gharsallah
    Clinical Neurology and Neurosurgery.2024; 239: 108206.     CrossRef
  • Diagnosis and treatment of Rosai-Dorfman disease of the spine: a systematic literature review
    Pan-pan Hu, Feng Wei, Xiao-guang Liu, Zhong-jun Liu
    Systematic Reviews.2021;[Epub]     CrossRef
  • Primary Rosai‑Dorfman disease of bone arising in the infantile ilium: A case report
    Yuya Izubuchi, Koji Suzuki, Yoshiaki Imamura, Hajime Katayama, Yusei Ohshima, Akihiko Matsumine
    Experimental and Therapeutic Medicine.2020;[Epub]     CrossRef
  • Long-Term Outcome of Spinal Extranodal Rosai-Dorfman Disease: A Report of Two Cases and Systematic Review
    Saleh S. Baeesa, Hani Mahboob, Yazid Maghrabi, Mohammad Binmahfoodh, Jaudah Almaghrabi
    World Neurosurgery.2020; 144: 1.     CrossRef
  • Nonresectable Thoracic Rosai-Dorfman Disease: A Case Report and Review of the Literature
    Cheng-Kai Lin, Yu-Duan Tsai
    World Neurosurgery.2019; 132: 309.     CrossRef
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    SunithaPalasamudram Kumaran, PushpaBhari Thippeswamy, BhavanaNagabhushan Reddy, Sankar Neelakantan, Sanjaya Viswamitra
    Neurology India.2019; 67(6): 1408.     CrossRef
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  • 7 Crossref

Clinical Article

A PET/CT-based Morphometric Study of Spinal Canal in Korean Young Adults: Anteroposterior Diameter from Cervical Vertebra to Sacrum
Moo Sung Kang, Jeong Yoon Park, Dong Kyu Chin, Kyung Hyun Kim, Sung Uk Kuh, Keun Su Kim, Yong Eun Cho
Korean J Spine 2012;9(3):165-169.   Published online September 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.3.165

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A PET/CT-based Morphometric Study of Spinal Canal in Korean Young Adults: Anteroposterior Diameter from Cervical Vertebra to Sacrum
Korean J Spine. 2012;9(3):165-169.   Published online September 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.3.165
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A PET/CT-based Morphometric Study of Spinal Canal in Korean Young Adults: Anteroposterior Diameter from Cervical Vertebra to Sacrum
Korean J Spine. 2012;9(3):165-169.   Published online September 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.3.165
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Objective

To establish normative data for spinal canal AP diameter from cervical vertebra to sacrum in the Korean young and to assess the exposed spinal canal after laminectomy which was related with restenosis by post-laminectomy membrane formation.

Methods

From PET/CT, axial bone-window CT of 83 young adults (20-29 years) were obtained, and we measured AP diameters of C3, C5, C7, T1, T4, T8, T12, L1, L3, L5 and S1. We also measured exposed AP diameter of C3, C5, C7, T1 and T2 above imaginary line for laminectomy.

Results

The shortest mean AP diameter was at C5 (14.5±1.5 mm), and the longest was at S1 (17.4±2.3 mm). AP diameter increased from C3 (14.6±1.1 mm) to T1 (16.1±1.2 mm) at cervical spine. In the thoracic spine, the diameter gradually decreased from T1 (16.1±1.2 mm) to T8 (14.6±1.3 mm) and increased to T12 (16.7±1.2 mm). The diameter decreased from L1 (16.7±1.3 mm) to L3 (15.7±1.9 mm), and it increased to S1 (17.4±2.3 mm) at lumbar spine. Exposed AP diameter above imaginary line for laminectomy was the longest at C3 (4.8±1.2 mm) and gradually decreased to T1 (3.3±0.9 mm) and T2 (0 mm).

Conclusions

Spinal AP diameter was the shortest in the mid-cervical area (C5) and increased to the upper thoracic area. From the upper thoracic vertebra, the diameter gradually decreased to the mid-thoracic vertebra (T8) and then increased to the lower thoracic vertebra. Lumbar vertebra also was similar with thoracic vertebra. Below T2, there was no exposed dural sac after laminectomy. This means that restenosis by post-laminectomy membrane formation can occur above T1.

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    Brian T. Ragel, Matthew McGehee, Nicolas Karvelas, Ahmed M. Raslan
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    Shinsuke Yoshida, Takaaki Suzuki, Masayuki Tanabe, Kazuo Saita
    Acta Neurochirurgica.2025;[Epub]     CrossRef
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    Brian T. Ragel, Tressa Riedman, Matthew McGehee, Ahmed M. Raslan
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    Hunter Xavier Leech, David Anthony Provenzano, Leonard DeRiggi, David Oliver-Smith
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    Interdisciplinary Neurosurgery.2023; 34: 101862.     CrossRef
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    Jia-Xing Yu, Tao Hong, Timo Krings, Chuan He, Ming Ye, Li-Yong Sun, Xiao-Dong Zhai, Si-Shi Xiang, Yong-Jie Ma, Li-Song Bian, Jian Ren, Peng-Yu Tao, Jing-Wei Li, Fan Yang, Gui-Lin Li, Feng Ling, Hong-Qi Zhang
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  • Biometrics of the Cervical Spinal Canal and Cord by Computer Tomography in Togo
    Abdoulatif Amadou, Lantam Sonhaye, Kossivi Apetse, Komlan Amoussou, Mazamaesso Tchaou, Bidamin N’timon, Kahabilou Atsa Agbangba, Gani Watara, Komlavi Adjenou
    Open Journal of Radiology.2017; 07(01): 45.     CrossRef
  • 15,707 View
  • 118 Download
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Case Report

Thoracic Spinal Epidural Cavernous Hemangioma: A Case Report and Review of the Literature.
Hyun Lee, Byeong Wook Hwang, Sang Ho Lee
Korean J Spine 2010;7(3):180-183.

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Thoracic Spinal Epidural Cavernous Hemangioma: A Case Report and Review of the Literature.
Korean J Spine. 2010;7(3):180-183.
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Thoracic Spinal Epidural Cavernous Hemangioma: A Case Report and Review of the Literature.
Korean J Spine. 2010;7(3):180-183.
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We report a very rare case of thoracic epidural cavernous hemangioma in a 69-year-old male. He complained of a three-year history of dull ache at the interscapular region and progressive numbness and weakness of the lower extremities. He had been suffering from gait disturbance and difficulty in urination and defecation for the previous three months. Preoperative magnetic resonance images showed characteristic features: a lobulated epidural mass, which was isointense to the spinal cord on T1-weighted images and hyperintense to the spinal cord on T2-weighted images, in the posterior spinal canal of the upper thoracic spine with contrast enhancement and extension through the intervertebral foramen. A right hemilaminectomy was performed at the T1, T2, T3 and T4 levels. After bilateral flavectomy, using a microsurgical technique, total excision of the mass was successfully achieved. The patient improved dramatically, both in motor strength and sensations, after the operation. Presumptive preoperative diagnosis of epidural cavernous hemangioma could render the surgical approach less invasive to avoid severe intraoperative bleeding.
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