Trans-facet joint approach to treat thoracic spinal stenosis due to anterior and posterior compression

[Objective]To investigate the clinical outcomes and surgical safety of trans-facet joints approach to treat thoracic spinal stenosis due to anterior and posterior compression. [Methods]A retrospective analysis was performed in 19 patients who had anterior and posterior compression of thoracic spinal stenosis and received trans-facet joint approach combined with total laminectomy decompression,interbody fusion and internal fixation operation between May 2006 and March 2009.There were 5 male and 14 female patients ranging from 45～70 years(mean,59.1 years).The disease course was 10～52 months(average,20 months).There were 11 patients with thoracic disc herniation(TDH) and ossification of the ligamentum flavum(OLF),and 8 patients with ossification of posterior longitudinal ligament(OPLL) and OLF.The lesion segments were T4、5 in 1,T5、6 in 1,T6、7 in 3,T8、9 in 2,T9、10 in 3,T10、11 in 6,and T11、12 in 3 patients.The postoperative curative effect was measured by JOA score and Frankel score system.[Results]The operation time was 150-270min(mean,195 min),with an averaged blood loss of 785 ml.Flotation method was performed in 2 patients due to epidural adhesions with OLF.Cerebrospinal fluid leakage occurring in 4 patients,and healed well after repair.There was one patient with wound infection and one patient with neurological symptom deterioration,but they recovered to preoperative level after methylprednisolone treatment.All patients followed up for 12～26 months(mean,16 months) and the symptoms were improved at different degrees without spinal instability and internal fixation loosing occurring.The JOA score had a significant recovery at 3 months and at the last follow-up compared with preoperation(P0.05).Based on Frankel score system at last follow-up,there was A in one,B in 4,C in 5,D in 6,and E in 3 patients.[Conclusion]The trans-facet joint approach is feasible in treating thoracic spinal stenosis due to anterior and posterior compression.A firm fixation besides the complete decompression will achieve satisfactory clinical results.