Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note
<i>Background and Objectives</i>: Thoracic ossification of the ligamentum flavum (OLF) often causes myelopathy and/or radiculopathy. The disease is frequently observed in East Asian populations. Although thoracic OLF in young athletes who have underwent decompression surgery has been rep...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-07-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/59/7/1303 |
| _version_ | 1797588350730764288 |
|---|---|
| author | Ken Ishii Norihiro Isogai Ryunosuke Urata Haruki Funao Tatsuya Igawa Hisanori Mihara Tetsuya Yamazaki |
| author_facet | Ken Ishii Norihiro Isogai Ryunosuke Urata Haruki Funao Tatsuya Igawa Hisanori Mihara Tetsuya Yamazaki |
| author_sort | Ken Ishii |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Thoracic ossification of the ligamentum flavum (OLF) often causes myelopathy and/or radiculopathy. The disease is frequently observed in East Asian populations. Although thoracic OLF in young athletes who have underwent decompression surgery has been reported, the removal of posterior spinal bony elements and ligamentous complex may often cause postoperative thoracolumbar instability. We established a novel surgical technique that preserves the posterior spinal elements, including the spinous processes, facet joints, and supraspinous and interspinous ligaments for thoracic OLF. This is the first case report to describe a navigation-assisted micro-window excision of thoracic OLF. <i>Case:</i> A 32-year-old male right-handed professional baseball pitcher with significant weakness and numbness in the left leg was referred to our hospital. The patient was diagnosed with thoracic OLF at T10-11 based on radiographic and magnetic resonance images in August 2022. After exposure of the left T10-11 laminae via a small unilateral incision, the location of T10-11 OLF was detected over the lamina by O-arm navigation. Then, the micro-window was made directly above the OLF using a navigated air drill, and the OLF was removed on the ipsilateral side. The contralateral side of OLF was also resected through the same micro-window, achieving complete spinal cord decompression. <i>Results</i>: The next day of the surgery, his leg weakness and numbness were significantly improved. Six weeks after the surgery, he started pitching. Three months after surgery, his symptoms had gone completely, and he pitched from the mound. Approximately 6 months after surgery, he successfully pitched in a professional baseball game. <i>Conclusions:</i> A navigation-assisted micro-window excision of thoracic OLF effectively preserved the spinal posterior bony elements and ligamentous complex. However, long-term clinical outcomes should be evaluated in future studies. |
| first_indexed | 2024-03-11T00:50:44Z |
| format | Article |
| id | doaj.art-4b08c618c55c4edcb2e1b787f893d56a |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-11T00:50:44Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-4b08c618c55c4edcb2e1b787f893d56a2023-11-18T20:24:49ZengMDPI AGMedicina1010-660X1648-91442023-07-01597130310.3390/medicina59071303Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical NoteKen Ishii0Norihiro Isogai1Ryunosuke Urata2Haruki Funao3Tatsuya Igawa4Hisanori Mihara5Tetsuya Yamazaki6Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo 160-8582, JapanSociety for Minimally Invasive Spinal Treatment (MIST), Tokyo 101-0063, JapanSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, JapanSociety for Minimally Invasive Spinal Treatment (MIST), Tokyo 101-0063, JapanSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, JapanDepartment of Orthopaedic Surgery, Yokohama Minami Kyousai Hospital, Yokohama 236-0037, JapanDepartment of Orthopaedic Surgery, Yokohama Minami Kyousai Hospital, Yokohama 236-0037, Japan<i>Background and Objectives</i>: Thoracic ossification of the ligamentum flavum (OLF) often causes myelopathy and/or radiculopathy. The disease is frequently observed in East Asian populations. Although thoracic OLF in young athletes who have underwent decompression surgery has been reported, the removal of posterior spinal bony elements and ligamentous complex may often cause postoperative thoracolumbar instability. We established a novel surgical technique that preserves the posterior spinal elements, including the spinous processes, facet joints, and supraspinous and interspinous ligaments for thoracic OLF. This is the first case report to describe a navigation-assisted micro-window excision of thoracic OLF. <i>Case:</i> A 32-year-old male right-handed professional baseball pitcher with significant weakness and numbness in the left leg was referred to our hospital. The patient was diagnosed with thoracic OLF at T10-11 based on radiographic and magnetic resonance images in August 2022. After exposure of the left T10-11 laminae via a small unilateral incision, the location of T10-11 OLF was detected over the lamina by O-arm navigation. Then, the micro-window was made directly above the OLF using a navigated air drill, and the OLF was removed on the ipsilateral side. The contralateral side of OLF was also resected through the same micro-window, achieving complete spinal cord decompression. <i>Results</i>: The next day of the surgery, his leg weakness and numbness were significantly improved. Six weeks after the surgery, he started pitching. Three months after surgery, his symptoms had gone completely, and he pitched from the mound. Approximately 6 months after surgery, he successfully pitched in a professional baseball game. <i>Conclusions:</i> A navigation-assisted micro-window excision of thoracic OLF effectively preserved the spinal posterior bony elements and ligamentous complex. However, long-term clinical outcomes should be evaluated in future studies.https://www.mdpi.com/1648-9144/59/7/1303ossification of the ligamentum flavum (OLF)thoracic spinecomputed tomography (CT)-based navigationnavigation-assisted micro-window excision |
| spellingShingle | Ken Ishii Norihiro Isogai Ryunosuke Urata Haruki Funao Tatsuya Igawa Hisanori Mihara Tetsuya Yamazaki Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note Medicina ossification of the ligamentum flavum (OLF) thoracic spine computed tomography (CT)-based navigation navigation-assisted micro-window excision |
| title | Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note |
| title_full | Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note |
| title_fullStr | Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note |
| title_full_unstemmed | Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note |
| title_short | Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note |
| title_sort | navigation assisted micro window excision of thoracic ossification of ligamentum flavum mishima surgery in professional baseball pitchers a case report and technical note |
| topic | ossification of the ligamentum flavum (OLF) thoracic spine computed tomography (CT)-based navigation navigation-assisted micro-window excision |
| url | https://www.mdpi.com/1648-9144/59/7/1303 |
| work_keys_str_mv | AT kenishii navigationassistedmicrowindowexcisionofthoracicossificationofligamentumflavummishimasurgeryinprofessionalbaseballpitchersacasereportandtechnicalnote AT norihiroisogai navigationassistedmicrowindowexcisionofthoracicossificationofligamentumflavummishimasurgeryinprofessionalbaseballpitchersacasereportandtechnicalnote AT ryunosukeurata navigationassistedmicrowindowexcisionofthoracicossificationofligamentumflavummishimasurgeryinprofessionalbaseballpitchersacasereportandtechnicalnote AT harukifunao navigationassistedmicrowindowexcisionofthoracicossificationofligamentumflavummishimasurgeryinprofessionalbaseballpitchersacasereportandtechnicalnote AT tatsuyaigawa navigationassistedmicrowindowexcisionofthoracicossificationofligamentumflavummishimasurgeryinprofessionalbaseballpitchersacasereportandtechnicalnote AT hisanorimihara navigationassistedmicrowindowexcisionofthoracicossificationofligamentumflavummishimasurgeryinprofessionalbaseballpitchersacasereportandtechnicalnote AT tetsuyayamazaki navigationassistedmicrowindowexcisionofthoracicossificationofligamentumflavummishimasurgeryinprofessionalbaseballpitchersacasereportandtechnicalnote |