Acromegalic Arthropathy and Ossification of the Yellow Ligament Treated with an Interlaminar Full-Endoscopic Approach: A Case Report Full-endoscopic decompression in a patient with acromegaly and Ossification of the Posterior Longitudinal Ligament
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Abstract
Introduction: Acromegalic arthropathy is a cause of morbidity and functional disability, affecting large peripheral joint, especially the spine. Affected patients can suffer from lumbar and sciatic pain, with or without radiculopathy. Due to the severe arthrosis, stenosis with ossification of the ligamentum flavum can often occur.
Patient history: This study presents a 57-year-old patient with acromegalic arthropathy resulting from a growth hormone secreting pituitary macroadenoma. He was previously submitted to transsphenoidal surgery and present a history of L4-L5 decompression due to disc herniation and bilateral knee arthroplasty. The condition evolved to an acute left lumbar sciatic pain and the patient was refractory to clinical and physical therapy treatment. Surgical procedure: Decompression and discectomy were performed through an interlaminar endoscopic approach. Cutting and diamond burs and Keirrinson-type forceps were used for decompression. Diamond burs were used in the calcified yellow ligament and in the intervertebral disc to remove the protruding disc.Imaging exams: Preoperative exams showed calcified disc herniation and stenosis, with ossification of the posterior longitudinal ligament. Postoperative exams showed good decompression, removal of the calcified disc herniation and ossification of the posterior longitudinal ligament.Patient follow-up: Immediate resolution of sciatica pain and neurological deficit, with a negative nerve stretching test. At one-year follow-up, the patient had no return of radicular symptoms.Conclusion: Endoscopic surgery can be a reliable treatment option in approaching patients with severe stenosis of the spinal canal associated with calcified disc hernias and ossification of the ligamentum flavum, even when submitted to previous surgeries. This approach also presents benefits of a minimally invasive surgery.
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