{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T12:46:47Z","timestamp":1771505207860,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: 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. Case: 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. Results: 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. Conclusions: 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.<\/jats:p>","DOI":"10.3390\/medicina59071303","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T08:35:47Z","timestamp":1689323747000},"page":"1303","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0094-7918","authenticated-orcid":false,"given":"Ken","family":"Ishii","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan"},{"name":"Department of Orthopaedic Surgery, Edogawa Hospital, Tokyo 133-0052, Japan"},{"name":"New Spine Clinic Tokyo (Tentative), Tokyo 102-0093, Japan"},{"name":"Society for Minimally Invasive Spinal Treatment (MIST), Tokyo 101-0063, Japan"},{"name":"Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9365-530X","authenticated-orcid":false,"given":"Norihiro","family":"Isogai","sequence":"additional","affiliation":[{"name":"Society for Minimally Invasive Spinal Treatment (MIST), Tokyo 101-0063, Japan"},{"name":"Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4506-2099","authenticated-orcid":false,"given":"Ryunosuke","family":"Urata","sequence":"additional","affiliation":[{"name":"Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8192-8342","authenticated-orcid":false,"given":"Haruki","family":"Funao","sequence":"additional","affiliation":[{"name":"Society for Minimally Invasive Spinal Treatment (MIST), Tokyo 101-0063, Japan"},{"name":"Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3320-4934","authenticated-orcid":false,"given":"Tatsuya","family":"Igawa","sequence":"additional","affiliation":[{"name":"Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan"},{"name":"Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Otawara 329-2763, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3202-1864","authenticated-orcid":false,"given":"Hisanori","family":"Mihara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yokohama Minami Kyousai Hospital, Yokohama 236-0037, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuya","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yokohama Minami Kyousai Hospital, Yokohama 236-0037, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3171\/spi.2006.4.3.191","article-title":"Surgical treatment of 40 patients with thoracic ossification of the ligamentum flavum","volume":"4","author":"Li","year":"2006","journal-title":"J. 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