1/8. Symptomatic ossification of the posterior longitudinal ligament of the lumbar spine. Case report.The authors report a case of focal ossification of the posterior longitudinal ligament (OPLL) behind the L-3 vertebral body. This is relatively rare among previously reported cases in the literature. Magnetic resonance (MR) imaging revealed that the ossifying portion of the PLL was impinging on the left L-3 nerve root. Contrast enhancing hypertrophic PLL was also demonstrated around the ossification and along the lumbosacral PLL. Via a laminectomy and wide excision of the PLL the lesion was removed. Pathological examination revealed a nodule composed of fibrous cartilage, lamina bone, and mature fat marrow. Enchondral ossification could be identified under a microscope. The authors believe that preoperative MR imaging evaluation is important for the detection of the relationship between an OPLL and the neural structure. Excision of the symptomatic OPLL should be performed when needed to obtain adequate nerve root decompression.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/8. Radicular compression by lumbar intraspinal epidural gas pseudocyst in association with lateral disc herniation. role of the posterior longitudinal ligament.Among unusual abnormalities of the lumbar spine reported since the introduction of Computed tomography (CT), the presence of gas lucency in the spinal canal, known as vacuum phenomenon, is often demonstrated. On the contrary, epidural gas pseudocyst compressing a nerve root in patients with a lateral disc herniation has rarely been reported. We report a case of a 44-year-old man who experienced violent low back pain and monolateral sciatica, exacerbated by orthostatic position, one week before admission. A lumbosacral spine CT showed the presence of vacuum phenomenon associated with a degenerated disc material and a capsulated epidural gas collection with evidence of root compression. A microsurgical interlaminar approach was carried out and, before the posterior longitudinal ligament was entered, a spherical "bubble" compressing the nerve roots was observed. The capsulated pseudocyst was dissected out, peeled off and excised en bloc. A large part of the posterior longitudinal ligament and the lateral disc herniation were removed. Postoperatively the patient was completely free of symptoms. The mechanism of exacerbation of pain was probably due to the increased radicular compression in the upright posture and, besides the presence of a lateral disc herniation, could be related to a pneumatic squeezing of gas from the intervertebral space into the well capsulated sac by the solicitated L4-L5 motion segment. Histological study of the wall of the pseudocyst showed the presence of fibrous tissue identical to the ligament. We conclude that, in case of a lumbar disc herniation, it is recommended to perform a complete microdiscectomy and an accurate removal of the involved portion of posterior longitudinal ligament in order to prevent pseudocystic formations.- - - - - - - - - - ranking = 1.6keywords = ligament (Clic here for more details about this article) |
3/8. A new consideration in athletic injuries. The classical ballet dancer.The professional ballet dancer presents all of the problems of any vigorous athlete. The problems include osteochondral fractures, fatigue fractures, sprains, chronic ligamentous instability of the knee, meniscal tears, impingement syndrome, degenerative arthritis of multiple joints and low back pain. attention to minor problems with sound conservative therapy can avoid many major developments and lost hours. Observations included the extraordinary external rotation of at the hip without demonstrable alteration in the hip version angle and hypertrophy of the femur, tibia and particularly the second metatarsal (in female dancers). Careful evaluation of the range of motion of the extremities, serial roentgenographic examination, and systematic review of previous injuries, training programs and rehearsal techniques have been evaluated in a series of cases to provide the basis for advice to directors and teachers of the ballet.- - - - - - - - - - ranking = 0.2keywords = ligament (Clic here for more details about this article) |
4/8. Therapy of spondylolisthesis by repositioning and fixation of the olisthetic vertebra.A new method for reduction of the slip and stabilization in spondylolisthesis is presented. A detailed description of the operative technique is given. Of special importance to repositioning of the olisthetic vertebra is sectioning of the ilio-lumbar and ilio-transverse ligaments. It is also most important to remove a portion of the superior surface of S1 in those cases with greater than 30 per cent olisthesis. A distinction in the technique of surgery is drawn between cases with less than 30 per cent of slip and those with greater than 30 per cent. In those with less than 30 per cent 2 bone grafts taken from one iliac crest are placed between the repositioned body of L5 and the body of S1. In those with more than 30 per cent slip grafts are not necessary. In these a portion of the superior surface of S1 is removed in such a way that the body of S1 fits snugly against the under surface of the repositioned body of L5. A special traction apparatus with wires through the spinous processes of L3 and L4 is used to accomplish reduction of the olisthetic vertebra. This apparatus is spring-loaded and is mounted on a modified Milwaukee brace. The patient remains in bed while this is worn. When it is believed that there is enough solidity in the fusion between the bodies of L5 and S1 the traction apparatus is removed and the patient allowed up.- - - - - - - - - - ranking = 0.2keywords = ligament (Clic here for more details about this article) |
5/8. Spinal compression due to ossified yellow ligament: a short series of 5 patients and literature review.BACKGROUND: Ossification of ligamentum flavum in the thoracic region causing compressive myelopathy among middle-aged patients is a poorly described entity. CASE DESCRIPTION: Five patients of Indian origin with OYL are described. Their clinical presentations, surgical options, and long-term outcome are presented. Radiologic and clinical follow-up of one of the patient is described over a span of 10 years. CONCLUSIONS: Decompressive laminectomy and excision of the OYL is the commonly performed surgical procedure. A rapid neurologic improvement follows decompression. The persistent spasticity in certain patients is attributed to irreversible changes within the cord. The disease is thought to be progressive in nature. The prolonged follow-up of these patients suggests that the long-term prognosis is poor. Selective racial involvement and variable clinical presentations, with treatment options, are discussed.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
6/8. Cyst of the ligamentum flavum: report of six cases.Six cases of cyst of the ligamentum flavum with compression of a lumbar nerve root are reported. All patients exhibited recurrent back pain and sciatica. Investigation included computed tomography, myelography, or both. The correct diagnosis was reached before operation in only half the patients. High-resolution computed tomography performed in the four last patients outlined the cystic lesion with its low-density center. Surgical excision was performed in all patients. Microscopic examination showed a dense fibrous cyst arising from the ligamentum flavum. The lumen contained myxoid or necrotic material, but no epithelial lining. Cysts of the ligamentum flavum must be considered in the differential diagnosis of causes of sciatica. A firm radiological diagnosis may, at present, still require myelography combined with high-resolution computed tomography. Differentiation from synovial or ganglion cysts of the spine is discussed.- - - - - - - - - - ranking = 1.4keywords = ligament (Clic here for more details about this article) |
7/8. Thoracic dorsal ramus entrapment. Case report.Entrapment of the dorsal ramus of a thoracic spinal nerve is described in a patient with chronic back pain and sensory disturbance in the cutaneous territory served by the T3-5 dorsal rami. The dorsal ramus of the T-4 nerve was found to be compressed by a bone spur involving the inferior T-4 apophyseal facet. The point of entrapment was a tunnel bounded by the transverse process, apophyseal joint, rib, and superior costotransverse ligament.- - - - - - - - - - ranking = 0.2keywords = ligament (Clic here for more details about this article) |
8/8. Supraspinous ligament avulsion: a case report.Avulsion of a supraspinous ligament is one potential cause of low back pain. Since the symptom pattern of this condition may mimic that of other, more common, conditions, a thorough biomechanical and radiological examination is necessary to ensure proper and successful management. The necessity for a thorough and complete biomechanical, laboratory and x-ray evaluation is emphasized before successful treatment can be initiated.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |