1/46. Surgical approach to ossification of the thoracic yellow ligament.BACKGROUND: Symptomatic ossification of the yellow ligament (OYL) at the lower thoracic level is uncommon. Although wide laminectomy has, until now, been the primary treatment for this disease, we propose a less invasive technique based on a new method of three-dimensional computed tomography (CT). methods: The clinical features and radiologic imaging findings of 37 patients with OYL (mean age, 54 years) were analyzed. The surgical approach was selected based on the position of the depicted OYL on 3D CT scan in each patient. RESULTS: The male-to-female ratio was 3:1. Involvement of the upper thoracic region was seen 11 times; of the middle region 8 times, and of the lower region 40 times (several patients had involvement in more than one region). About half of the patients complained of gait disturbance on admission caused by the markedly enlarged OYL. No postoperative complications were found. Neurologic deterioration was observed in only one patient. CONCLUSIONS: OYL should be treated as early as possible, using the least invasive technique available. By using 3D CT, we were able to perform limited surgery consisting of foraminotomy or extended partial laminectomy at the affected level after confirming the anatomic location of the OYL. In laterally extended OYL, it is necessary to decompress the radicular artery in order to prevent ischemic damage to the spinal cord.- - - - - - - - - - ranking = 1keywords = spinal cord, spinal, cord (Clic here for more details about this article) |
2/46. pathology of the spinal cord damaged by ossification of the posterior longitudinal ligament associated with spinal cord injury.A 63-year-old male became quadriplegic after spinal injury associated with ossification of the posterior longitudinal ligament of the cervical spine and died 4 years later. A postmortem examination of the cervical spinal cord showed various unfavorable pathological changes accounting for severe myelopathy.- - - - - - - - - - ranking = 9.2389240802319keywords = spinal cord, spinal, cord (Clic here for more details about this article) |
3/46. Sternal splitting approach to upper thoracic lesions located anterior to the spinal cord.The sternal splitting approach for upper thoracic lesions located anterior to the spinal cord is described. The sternal splitting approach can be effectively applied to lesions from the T-1 to T-3 levels. The aortic arch prevents procedures below this level. The approach is straight toward the T1-3 vertebral bodies and provides good surgical orientation. The sternal splitting approach was applied to five patients with metastatic spinal tumors at the C7-T3 levels and three patients with ossification of the posterior longitudinal ligament at the T1-3 levels. No postoperative neurological deterioration occurred. Two patients had postoperative hoarseness. The sternal splitting approach to the upper thoracic spine is recommended for hard lesions, extensive lesions requiring radical resection, and lesions requiring postoperative stabilization with spinal instrumentation.- - - - - - - - - - ranking = 5.4778481604639keywords = spinal cord, spinal, cord (Clic here for more details about this article) |
4/46. Contact of hydroxyapatite spacers with split spinous processes in double-door laminoplasty for cervical myelopathy.We developed a new type of spacer made of hydroxyapatite (the STSS spacer) for double-door laminoplasty, and evaluated the contact of 93 STSS spacers with the split spinous processes in 20 patients with double-door laminoplasty. Contact was assessed by measuring the extent of touch of the spacer to the spinous processes, classified into four categories based on computed tomography (CT) images: excellent, complete touch on both sides of the spacer to the spinous process; good, complete touch on one side and more than half touch on the other side; fair, more than half touch on both sides; poor, half or less touch on at least one side. Excellent contact was achieved in 65 spacers (69.9%); good, in 13 (14.0%); fair, in 11 (11. 8%); and poor, in 4 (4.3%). The percentages of excellent or good categories were 75.0% at the C3 level, 73.7% at the C4 level, 78.9% at the C5 level, 90.0% at the C6 level, and 100% at the C7 level. The contact rate of the STSS spacer with the spinous process was better than that achieved with other spacers, probably because the characteristic shape of the STSS spacer was compatible with the widened space between the bilateral spinous processes; i.e., it is trapezoidal on both the axial and the frontal sections. However, the appropriate size of the spacer must be selected in accordance with the size of the spinous process to obtain higher percentages of excellent or good contact.- - - - - - - - - - ranking = 0.070446636875647keywords = cord (Clic here for more details about this article) |
5/46. Anterior cervical micro-dural repair of cerebrospinal fluid fistula after surgery for ossification of the posterior longitudinal ligament. Technical note.BACKGROUND: cerebrospinal fluid (CSF) fistulas may occur during anterior cervical surgery performed for the resection of ossification of the posterior longitudinal ligament (OPLL), as OPLL occasionally erodes to and through the dura. These fistulas have been variously managed with gelfoam, dural substitutes sutured in place, fibrin glue, lumbar drains, and lumboperitoneal shunts. However, more adequate dural repair is now feasible with the 1.4-mm microdural titanium stapler. methods: A 59-year-old female with OPLL and moderate to severe myelopathy (Nurick Grade IV) had a C3-C7 anterior corpectomy with fusion using Orion plates followed by a C3-T1 posterior wiring and fusion with halo application. During the anterior approach, a 5-mm CSF fistula at C4-C5 was directly repaired under the operating microscope using a 1.4-mm microdural stapler, bovine pericardial graft, and fibrin glue. Immediately postoperatively, a lumboperitoneal shunt was also placed. RESULTS: Postoperatively, her myelopathy improved to a mild to moderate level (Nurick Grade II). Her acute left deltoid plegia resolved within 3 months. CONCLUSIONS: The 1.4-mm microdural stapler makes "watertight" closure of anterior cervical CSF fistulas more feasible.- - - - - - - - - - ranking = 1.1946204011596keywords = spinal (Clic here for more details about this article) |
6/46. Extensive cervical laminoplasty for patients with long segment OPLL in the cervical spine: an alternative to the anterior approach.We investigated treatment of long segment cervical OPLL by posterior decompression using a laminoplasty technique. Our aim was to both decompress the spinal cord and also to preserve neck motion. There were 38 patients treated by this posterior approach. Twenty-eight patients underwent C1-C7 expanding laminoplasty, 4 patients underwent C1-T1 expanding laminoplasty, and 6 patients C2-C7 expanding laminoplasty. The transverse width of the open-door laminoplasty was sufficient to achieve decompression of not only the spinal cord but also the nerve root outlets at each laminoplasty level. There were no complications related to this surgical technique, nor late deterioration in the mean follow up period of 4. 5 years. We propose expanding laminoplasty as an important option for the treatment of long segment cervical OPLL.- - - - - - - - - - ranking = 2keywords = spinal cord, spinal, cord (Clic here for more details about this article) |
7/46. Simultaneous cervical diffuse idiopathic skeletal hyperostosis and ossification of the posterior longitudinal ligament resulting in dysphagia or myelopathy in two geriatric North Americans.BACKGROUND: Cervical diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) rarely coexist in the North American population. Here, different surgical strategies were used to manage simultaneous DISH and OPLL resulting in dysphagia or myelopathy in two geriatric patients. methods: A 74-year-old male with esophageal compression and dysphagia attributed to DISH, and cord compression with myelopathy due to OPLL, was treated with a cervical laminectomy followed by anterior DISH resection. On the other hand, an 80-year-old male with asymptomatic DISH but moderate myelopathy (Nurick Grade III) secondary to OPLL required only a cervical laminectomy. RESULTS: In the first patient, dysphagia resolved within 3 months of surgery, while in the second individual, myelopathy improved to Nurick Grade I (mild myelopathy) within 6 months postoperatively. Improvement in both patients was maintained 1 year after surgery. CONCLUSIONS: While DISH and OPLL may coexist in geriatric patients, only those with dysphagia should undergo DISH resection, while others demonstrating myelopathy should have laminectomy alone.- - - - - - - - - - ranking = 0.070446636875647keywords = cord (Clic here for more details about this article) |
8/46. 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 = 2keywords = spinal cord, spinal, cord (Clic here for more details about this article) |
9/46. Ossification of the posterior longitudinal ligament in vitamin d-resistant rickets: case report and review of the literature.STUDY DESIGN: A case report of cervical myelopathy caused by ossification of the posterior longitudinal ligament in a patient with vitamin d-resistant rickets is presented together with a review of literature. OBJECTIVE: To report the diagnosis of ossification of the posterior longitudinal ligament in a white woman with vitamin d-resistant rickets. SUMMARY OF BACKGROUND DATA: The association between ossification of the posterior longitudinal ligament and untreated vitamin d-resistant rickets has been reported in japan, but infrequently in white populations. In whites, ossification of the posterior longitudinal ligament is closely associated with diffuse idiopathic skeletal hyperostosis. A clear association between ossification of the posterior longitudinal ligament and vitamin d-resistant rickets in white populations has not yet been established. methods: The medical record and imaging studies of a patient treated at the authors' institution for cervical myelopathy caused by ossification of the posterior longitudinal ligament in the setting of treated vitamin d-resistant rickets were reviewed. A medline search of the medical literature between 1966-1999 was performed to identify pertinent studies and similar case reports. RESULTS: The occurrence of spinal stenosis in untreated adults with vitamin d-resistant rickets has been reported in all regions of the spine in Japanese patients. The association between ossification of the posterior longitudinal ligament and untreated vitamin d-resistant rickets was first reported in japan, where ossification of the posterior longitudinal ligament is endemic. This association may be incidental, because reports on ossification of the posterior longitudinal ligament in whites are not as frequent as in Japanese, reflecting the higher prevalence of this condition in japan. CONCLUSION: Ossification of the posterior longitudinal ligament and ossification of the posterior longitudinal ligament associated with deranged calcium or phosphate metabolism may be different pathologic entities sharing a common outcome. Adequate treatment of vitamin d-resistant rickets may not always prevent or reverse ossification of the posterior longitudinal ligament.- - - - - - - - - - ranking = 0.30937071710758keywords = spinal, cord (Clic here for more details about this article) |
10/46. 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 = 0.070446636875647keywords = cord (Clic here for more details about this article) |
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