1/6. Cervical and thoracic juxtafacet cysts causing neurologic deficits.STUDY DESIGN: case reports and review of the literature. OBJECTIVES: To review the clinical features, treatment, and outcome of juxtafacet cysts. SUMMARY OF BACKGROUND DATA: There have previously been 4 reported cases of thoracic juxtafacet cysts and 19 cases of cervical juxtafacet cysts. Cervical cysts have usually originated from the cruciate ligament and caused myelopathy. Thoracic cysts are usually signaled by myelopathy. methods: The records of the neurosurgery Department of Royal Adelaide Hospital from 1980 through 1995 were reviewed for cases of intraspinal juxtafacet cysts. RESULTS: Eight cases of intraspinal juxtafacet cysts were identified; six were in the lumbar spine. One patient had a cervical cyst related to a facet joint and had unilateral radiculopathy. A second patient with a thoracic cyst had the gradual onset of myelopathy. Both patients had surgical excision of the cyst without resection of the adherent dura. The symptoms and neurologic signs improved in each case. CONCLUSIONS: Cervical and thoracic juxtafacet cysts are rare lesions that are usually signaled by myelopathy. Results of surgery are excellent in most cases, even if the cyst is not completely excised.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/6. Ossification of the ligamentum flavum in a Caucasian. Case report.There have been few reports of ossification of the yellow ligaments causing spinal cord compression in Caucasian population. This disease is described mainly in Japanese patients and is termed as "Japanese disease". We describe the case of a 58-year-old Caucasian male with progressive paraparesis. Radiographic features were suggestive of ossification of the yellow ligaments in the lower thoracic level causing spinal cord compression. Early decompressive laminectomy and removal of the ossified ligament resulted in a marked clinical improvement. The etiological hypothesis, epidemiological, histological, clinical and radiological features of this disease are reviewed.- - - - - - - - - - ranking = 7keywords = ligament (Clic here for more details about this article) |
3/6. paraparesis in a black man brought on by ossification of the ligamentum flavum: case report and review of the literature.We present the second case of paraparesis secondary to ossification of the ligamentum flavum at the midthoracic region in a black man. Ossification of the ligamentum flavum is frequently described in the Japanese population where the presentation is often in the lower thoracic region. The patient is a 37-year-old black man who, over the 6 months before admission, noticed progressive paraparesis. CT myelogram revealed severe thoracic stenosis by an ossified ligamentum flavum from T4 to T7 with most severe involvement at the T5, T6, and T7 levels. The patient underwent multilevel laminectomies and medial facetectomies from T4 to T7. Over the past decade, ossification of the ligamentum flavum has been reported with increasing frequency in non-Asian patients. This is the third case report in a black man. In addition, ossification of the ligamentum flavum in this particular location is rarely reported. The increased use of advanced neuroimaging techniques in the evaluation of "back pain" may reveal that the prevalence of this condition is higher than expected in non-Asian populations. Improvement in neurologic symptoms secondary to decompressive laminectomies will depend on the degree and duration of spinal cord compression.- - - - - - - - - - ranking = 9keywords = ligament (Clic here for more details about this article) |
4/6. Sudden onset of paraparesis caused by hypertrophy of the thoracic posterior longitudinal ligament.STUDY DESIGN: Case report of a rare form of hypertrophy of the thoracic posterior longitudinal ligament (HPLL), causing paraparesis. OBJECTIVE: To describe this very rare pathological condition in the thoracic spine and the results of surgical intervention. SETTING: A department of orthopaedic surgery in japan. methods: A 61-year-old man presented with acute paraparesis associated with HPLL in the thoracic region. A radiographic and pathological review of the case was conducted. Anterior decompression was performed, and he was followed for 3 years after the operation. RESULTS: Pathologic examination of the surgical specimen revealed proliferation of fibrocartilage and calcification. The patient's paraparesis ameliorated after the operation. CONCLUSION: For this case of myelopathy due to HPLL in the thoracic spine, urgent decompression gave excellent results. Clinical awareness of HPLL may aid correct diagnosis and prompt therapy.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |
5/6. Transient paraparesis after laminectomy in a patient with multi-level ossification of the spinal ligament.Acute neurologic deterioration is not a rare event in the surgical decompression for thoracic spinal stenosis. We report a case of transient paraparesis after decompressive laminectomy in a 50-yr-old male patient with multi-level thoracic ossification of the ligamentum flavum and cervical ossification of the posterior longitudinal ligament. Decompressive laminectomy from T9 to T11 was performed without gross neurological improvement. Two weeks after the first operation, laminoplasty from C4 to C6 and additional decompressive laminectomies of T3, T4, T6, and T8 were performed. paraparesis developed 3 hr after the second operation, which recovered spontaneously 5 hr thereafter. CT and MRI were immediately performed, but there were no corresponding lesions. Vascular compromise of the borderlines of the arterial supply by microthrombi might be responsible for the paraparesis.- - - - - - - - - - ranking = 6keywords = ligament (Clic here for more details about this article) |
6/6. Transient paraparesis after laminectomy for thoracic myelopathy due to ossification of the posterior longitudinal ligament: a case report.STUDY DESIGN: Case report. OBJECTIVES: We report a case with thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL) of the spine, in which neurologic deterioration progressed after laminectomy and was markedly reversed after additional posterior instrumented fusion. SUMMARY OF BACKGROUND DATA: Many different surgical procedures may be used in the treatment of thoracic OPLL. However, the possibility of postoperative paraplegia remains a major risk, and consistent protocols and procedures for surgical correction of thoracic OPLL have not been established. methods: The patient was a 53-year-old man with continuous OPLL at T3-T8 that compressed the spinal cord anteriorly. Anterior decompression surgery employing a posterior approach was initiated, but during OPLL extirpation electrophysiologic monitoring of spinal cord activity showed abnormalities. As a result, the procedure was converted to a wide laminectomy. Over the next 4 weeks, kyphosis of the thoracic spine increased and myelopathy worsened, producing severe paraparesis. RESULTS: Four weeks after surgery, posterior instrumented fusion (T1-L1) was performed without correction of the kyphosis. After the fusion, neurologic deficits gradually recovered and the patient was fully recovered after 10 months. At follow-up 15 years after the fusion, no neurologic deterioration was seen despite the presence of residual anterior impingement of spinal cord by OPLL. CONCLUSIONS: The present case suggests that kyphosis and instability are major factors that affect the severity of thoracic myelopathy due to OPLL, and posterior fusion with spinal instrumentation is a safe and effective adjunct procedure for surgical treatment of thoracic OPLL.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |