Clinical Analysis of Thoracic Spinal Stenosis

Kim, Young Soo; Shin, Hyung Shik

Abstract

Until recently, thoracic spinal stenosis has been thought to be an uncommon disease because the diagnosis has been obscured by its many different clinical manifestations and also there has been a lack of radiographic sensitivity and specificity in the evaluation of the thoracic spine. Fortunately, the significant advancements made in the radiographic evaluation of the thoracic spine has enabled a more accurate diagnosis and thus, there has been an increasing number of reports of thoracic spinal stenosis in the literature. The authors analyzed thirty cases of thoracic spinal stenosis over an 11-year period. These patients comprised 0.33% of all the spinal operations that were performed in our department during the same period. The patients in our series averaged 50.6 years of age(range 21~76) consisting of 2 men and 8 women who had been symptomatic for an average of 21 months. The common presenting symptoms were motor weakness(86.7%), sensory change(86.7%), bladder/bowel dysfunction(76.7%), and pain(70.0%). Diagnosis was made from plain x-rays, myelography, computerized tomography(CT), myelography-CT, and magnetic resonance imaging(MRI). The underlying causes of thoracic spinal stenosis were ossification of ligamentum flavum(OLF) (30.0%), hypertrophied facet(20.0%), herniated nucleus pulposus(13.3%), bony spur(10.0%), and mixed lesion(6.8%). Most instances of OLF were ound in the distal thoracic spinal canal and were degenerative in nature. All patients underwent operations and the surgical outcome was excellent in 36.7% and good in 40.0%. The results of our study suggest that the occurrence of thoracic spinal stenosis is more common than is currently recognized in the literature and that early diagnosis and proper surgical management is essential in obtaining a better surgical result.