1/14. Impact of longitudinal distance of the cervical spine on the results of expansive open-door laminoplasty.STUDY DESIGN: A retrospective study in patients who underwent expansive open-door laminoplasty (ELAP) for cervical myelopathy and in whom the cervical alignment was nonlordotic at the final follow-up to analyze the correlation between the longitudinal distance of the cervical spine and surgical results. OBJECTIVES: To determine the impact of longitudinal distance of the cervical spine on surgical results of ELAP and to propose a new concept, the redundant spinal cord, that may influence patient selection for ELAP. SUMMARY OF BACKGROUND DATA: Results in many studies have demonstrated that postoperative cervical alignment has significant effect on surgical results, and spines that are malaligned are thought to deteriorate. The current surgical data showed that not all patients with postoperative malalignment had poor surgical results. patients with cervical spondylotic myelopathy (CSM) tended to have better clinical results than those with ossification of the posterior longitudinal ligament (OPLL). methods: Results in 70 patients who underwent ELAP for cervical myelopathy with postoperative cervical malalignment were investigated. The longitudinal distance index (LDI) was defined as the length of a vertical line between the posteroinferior edges of C2 and C7 divided by the anteroposterior diameter of C4 and was measured on lateral neutral radiographs at final follow-up. Correlation between LDI and surgical results represented by Japanese Orthopedic association scores and percentage of recovery were analyzed statistically in each patient. RESULTS: patients with CSM had smaller LDI and better surgical results than those with OPLL. Weak but significant negative correlation was detected between LDI and percentage of recovery, indicating that longitudinal distance of the cervical spine may have some degree of impact on the surgical results of ELAP. CONCLUSION: A decrease in LDI represents shortening of the cervical spine caused by multiple disc degeneration and may influence surgical results of ELAP by inducing redundancy of the spinal cord in patients with postoperative malalignment.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
2/14. hypertrophy of the posterior longitudinal ligament is a prodromal condition to ossification: a cervical myelopathy case report.STUDY DESIGN: A histopathologic examination of a specimen that showed hypertrophy of the posterior longitudinal ligament of the cervical spine. OBJECTIVES: To illustrate the possibility of hypertrophy of the posterior longitudinal ligament as a prodromal condition to ossification of the posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA: Despite much study, the pathology of ossification of the posterior longitudinal ligament still remains unclear. Hypertrophic change often is seen in the part of the ossified ligament; however, there have been few histopathologic reports on hypertrophy of the posterior longitudinal ligament. Some reports have suggested that hypertrophy of the posterior longitudinal ligament is a prodrome of ossification of the posterior longitudinal ligament. methods: A 64-year-old man was admitted to the hospital because of gait disturbance and developed oliguria. In a plain radiograph, segmental ossification of the posterior longitudinal ligament was found at C4, C5, and C6. Computed tomograph myelogram revealed a soft tissue shadow, maximum 3.8 mm in diameter, on the dorsal side of the ossification of the posterior longitudinal ligament at C5 and C6. Magnetic resonance T1-weighted image (T1WI) showed an equivalent signal with the intervertebral disc on the dorsal side of ossification of the posterior longitudinal ligament. This lesion was enhanced with Gd-DTPA and confirmed as hypertrophy of the posterior longitudinal ligament. Cervical anterior decompression and fusion were performed using Yamaura's technique. The ossified and thickened lesion was elevated and removed en bloc. Then, hematoxylin-eosin and toluidine blue staining was performed to detect metachromasia. RESULTS: Macroscopic examination of the specimen revealed that soft tissue formation was connected with the C4-C5 intervertebral space and extended downward to C6-C7. Histopatholgically, collagen fibers were proliferating in the long-axis direction on both ventral and dorsal sides. This was surrounded by extended nucleus pulposus-like chondrocyte tissue, where endplate cartilage was detected around the C4 pedicle. Roux staining was low, and partial vascular and cellular infiltration was observed, although it was not marked. CONCLUSION: The herniated nucleus pulposus involving endplate cartilage from C4-C5 was limited to the superficial layer, and proliferation of nucleus pulposus-like chondrocytes occurred in the herniated tissue, where they might undergo a change in cell phenotype. The results of the present study support the hypothesis that hypertrophy of the posterior longitudinal ligament is a prodromal condition to ossification of the posterior longitudinal ligament.- - - - - - - - - - ranking = 1348.2696890617keywords = intervertebral, intervertebral disc, disc (Clic here for more details about this article) |
3/14. Clinics in diagnostic imaging (55). Ossification of the posterior longitudinal ligament.Ossification of the posterior longitudinal ligament (OPLL) of the cervical spine associated with diffuse idiopathic skeletal hyperostosis is described in a 70-year-old Caucasian man presenting with a rapidly progressive myelopathy. The acute nature of his myelopathic symptoms and cervical canal stenosis necessitated posterior decompressive surgery. Four other patients with OPLL are presented to illustrate the spectrum of imaging findings. The computed tomographic features of OPLL are distinctive.A 2-5 mm thick linear ossified strip along the posterior vertebral margin usually at mid cervical (C3 to C5) level characterises the condition. Magnetic resonance (MR) imaging is valuable in excluding possible cord damage and associated disc lesions prior to surgery. A calcified central sequestrated disc is the only condition that may be mistaken for the segmental and retrodiscal forms of OPLL In a clinical setting of compressive myelopathy, it is pertinent to distinguish between these two conditions since a sequestrated disc has a more favourable surgical prognosis. The merits and relevance of anterior and posterior surgery together with their possible complications are outlined.- - - - - - - - - - ranking = 4keywords = disc (Clic here for more details about this article) |
4/14. Cervical cord injury in an elderly man with a fused spine--a case report.We report a case of an elderly man presenting with co-existing diffuse idiopathic skeletal hyperostosis (DISH) and ossified posterior longitudinal ligament (OPLL) resulting in central cord syndrome. Only three such cases have been reported co-existing with DISH. The patient recovered most of his neurological deficit through conservative management. A discussion on the radiological features of DISH co-existing with OPLL and how these differ from ankylosing spondylitis (AS) follows.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
5/14. Cervical spinal cord compression attributable to a calcified intervertebral disc in a patient with X-linked hypophosphatemic rickets: case report and review of the literature.OBJECTIVE AND IMPORTANCE: X-linked hypophosphatemic rickets is a common inherited phosphate-wasting disorder, but it is a rare cause of spinal cord compression. We present the first reported case of a calcified intervertebral disc causing spinal canal stenosis in X-linked hypophosphatemic rickets. CLINICAL PRESENTATION: A 44-year-old woman presented with paresthesia of her left arm and a loss of grip in both hands. magnetic resonance imaging revealed a calcified intervertebral disc, as well as a posterior osteophytic bar causing marked cervical cord compression at C6/C7. INTERVENTION: An anterior cervical discectomy at C6/C7 and fusion with autologous bone graft were performed. The patient then exhibited significant improvement. CONCLUSION: A review of the 16 published cases demonstrates that thickening of the vertebral laminae, facet joint hypertrophy, and ossification of the intervertebral discs, posterior longitudinal ligament, and/or ligamentum flavum contribute to spinal canal stenosis in X-linked hypophosphatemic rickets. Those changes are caused by the disease itself and are unlikely to be related to long-term vitamin d treatment. Eleven of 16 patients were reported to have experienced favorable outcomes after surgery.- - - - - - - - - - ranking = 5597.3460076234keywords = intervertebral, intervertebral disc, disc (Clic here for more details about this article) |
6/14. Acute cervical cord injury associated with ossification of the posterior longitudinal ligament.OBJECTIVE: patients with ossification of the posterior longitudinal ligament (OPLL) sometimes present with acute spinal cord injury caused by only minor trauma. In the present study, we reviewed our experience of acute cervical cord injury associated with OPLL to understand the pathomechanisms and to provide clinical information for management of this disorder. methods: Twenty-eight patients were retrospectively analyzed. There were 26 men and 2 women, aged 45 to 78 years (mean, 63.0 yr). Most patients experienced incomplete spinal cord injury (Frankel Grade A, 3; B, 1; C, 15; and D, 9). RESULTS: Radiological studies revealed continuous- or mixed-type OPLL in 14 patients and segmental-type OPLL in 14 patients. The sagittal diameter of the spinal canal was reduced to 4.1 to 10 mm at the narrowest level as a result of OPLL. Developmental size of the spinal canal was significantly smaller in the group with segmental OPLL. magnetic resonance imaging scans revealed that spinal cord injury occurred predominantly at the caudal edge of continuous-type OPLL or at the disc levels. Surgery was performed in 24 patients either by posterior (18 patients) or anterior (6 patients) decompression at various time intervals after the trauma. Twenty patients (71%) displayed improvement in Frankel grade. CONCLUSION: The present study demonstrates the preexisting factors and pathomechanisms of acute spinal cord injury associated with cervical OPLL. magnetic resonance imaging is useful to understand the level and mechanism of injury. Further investigation will be needed to elucidate the role of surgical decompression.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
7/14. Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery. Report of three cases.The authors discuss the cases of three patients in whom thoracic paraplegia developed after lumbar spinal decompressive surgery for slight lumbar spinal canal stenosis. Careful computerized tomography myelography and magnetic resonance imaging examination of the thoracic spine revealed another compressive lesion (spinal cord tumor, disc herniation, osteophyte of vertebral body, and ossification of the ligamentum flavum). Additional thoracic decompressive surgery provided partial amelioration of each patient's neurological condition. The authors suggest that to avoid such a complication physical and radiographic examination of the thoracic spine should be performed preoperatively if the lumbar imaging is inconclusive.- - - - - - - - - - ranking = 2keywords = disc (Clic here for more details about this article) |
8/14. central nervous system superficial siderosis following spinal surgery.Superficial siderosis of the central nervous system is a rare progressive disease associated with hemosiderin deposition on the leptomeninges of the neuraxis. In addition to tumors and vascular lesions, dural sleeve pseudomeningoceles caused by brachial plexus avulsion injury may be the bleeding source in this disease. The authors describe a patient who underwent anterior cervical spine surgery for spinal cord compression due to the ossification of posterior longitudinal ligament. The operation was complicated by a dural tear and subsequent psedomeningocele formation. Nine years later, this patient developed superficial siderosis. The possible mechanisms involved in the development of superficial siderosis in this patient will be discussed.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
9/14. A transsternoclavicular approach for the anterior decompression and fusion of the upper thoracic spine. Technical note.The anterior approach is commonly used to reach the upper thoracic region to achieve decompression and stabilization; however, upper thoracic lesions are difficult to treat because of the regional anatomical structures, and this approach is associated with risks of complication. The authors evaluated the advantages of using a transsternoclavicular approach to aid in treating upper thoracic lesions. The procedure and surgery-related outcomes are discussed.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
10/14. Secondary medulla oblongata involvement following middle cervical spinal cord injury associated with latent traumatic instability in a patient with ossification of the posterior longitudinal ligament.STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of extension of edema and hemorrhage from initial C4-5 spinal injury to the medulla oblongata. SETTING: Center for Spinal Disorders and Injuries, Bibai Rosai Hospital, japan. methods: A 68-year-old man with ossification of the posterior longitudinal ligament (OPLL) had sustained tetraplegia after tumbling over a stone. Initially, the patient was diagnosed with an acute C4-5 spinal cord injury without radiological abnormalities and was treated conservatively. At 7 h after the injury, the patient had an ascending neurological deficit, which required respiratory assistance. magnetic resonance imaging revealed a marked swelling of the spinal cord above C4-5 extending to the medulla oblongata. RESULTS: Retrospective radiological assessment revealed that the spine was unstable at the injury level because of discontinuities in both anterior and posterior longitudinal ligaments. There was also signal intensity change within the retropharyngeal space at the C4-5 intervertebral disc. This injured segment was highly vulnerable to post-injury dynamic stenosis and easily sustained secondary neural damage. CONCLUSIONS: This case report emphasizes a careful radiological assessment of latent structural instability in patients with OPLL in order to detect and prevent deteriorative change in the spinal cord.- - - - - - - - - - ranking = 800.47800108906keywords = intervertebral, intervertebral disc, disc (Clic here for more details about this article) |
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