1/41. Analysis of the cervical spine alignment following laminoplasty and laminectomy.Very little detailed biomechanical examination of the alignment of the cervical spine following laminoplasty has been reported. We performed a comparative study regarding the buckling-type alignment that follows laminoplasty and laminectomy to know the mechanical changes in the alignment of the cervical spine. Lateral images of plain roentgenograms of the cervical spine were put into a computer and examined using a program we developed for analysis of the buckling-type alignment. Sixty-four patients who underwent laminoplasty and 37 patients who underwent laminectomy were reviewed retrospectively. The subjects comprised patients with cervical spondylotic myelopathy (CSM) and those with ossification of the posterior longitudinal ligament (OPLL). The postoperative observation period was 6 years and 7 months on average after laminectomy, and 5 years and 6 months on average following laminoplasty. Development of the buckling-type alignment was found in 33% of patients following laminectomy and only 6% after laminoplasty. Development of buckling-type alignment following laminoplasty appeared markedly less than following laminectomy in both CSM and OPLL patients. These results favor laminoplasty over laminectomy from the aspect of mechanics.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/41. High cervical disc lesions in elderly patients--presentation and surgical approach.The incidence of high cervical disc lesions is extremely rare, and the mechanism of their development is unclear. We report these three cases, and discuss the possible mechanisms. We also describe surgical strategies for these lesions. The first and second cases were an 82-year-old male and an 84-year-old male with retro-odontoid disc hernia. The third was an 83-year-old female with a herniated disc at C2/C3. To investigate Aetiological mechanisms of these lesions, we examined the findings on cervical images in extension and flexion, and compared the results in a younger than 80-year-old group and an older than 80-year-old group. The patients underwent surgery via a posterolateral intradural approach. Wide laminectomy and incision of the dentate ligaments enabled access to the ventral space of the upper cervical spinal canal and sufficient decompression. All patients became ambulatory postoperatively without special fixation of the cervical spine. In the younger group, the level mostly loaded during cervical movement was C5/6, however, the levels in the older group were C2/3 and C3/4. In elderly patients, less mobilization of the middle and/or lower cervical spine due to spondylotic change causes overloading at higher levels resulting in high cervical disc lesions. Retro-odontoid disc lesions can be caused by a herniated disc at C2/C3, which migrates upward. Regarding surgical strategy, the posterolateral intradural approach is less invasive and more advantageous for these lesions.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/41. Extraforaminal entrapment of the fifth lumbar spinal nerve by osteophytes of the lumbosacral spine: anatomic study and a report of four cases.STUDY DESIGN: An anatomic study of the associations between the fifth lumbar spinal nerve (L5 spinal nerve) and a lumbosacral tunnel, consisting of the fifth lumbar vertebral body (L5 vertebral body), the lumbosacral ligament, and sacral ala, and clinical case reports of four patients with lumbar radiculopathy secondary to entrapment of the L5 spinal nerve in the lumbosacral tunnel. OBJECTIVES: To delineate the anatomic, clinical, and radiologic features and surgical outcome of patients with entrapment of the L5 spinal nerve in the lumbosacral tunnel. SUMMARY OF BACKGROUND DATA: Although several cadaveric studies on a lumbosacral tunnel as a possible cause of L5 radiculopathy have been reported, few studies had focused on osteophytes of the L5-S1 vertebral bodies as the major component of this compressive lesion, and clinical reports on patients with this disease have been rare. methods: Lumbosacral spines from 29 geriatric cadavers were examined with special attention to the associations between osteophytes of the L5-S1 vertebral bodies and the L5 spinal nerve. Four patients with a diagnosis of the entrapment of the L5 spinal nerve by osteophytes at the lumbosacral tunnel were treated surgically, and their clinical manifestations and surgical results were reviewed retrospectively. RESULTS: The anatomic study demonstrated osteophytes of the L5-S1 vertebral bodies in seven of the 29 cadavers. Entrapment of the L5 spinal nerve in the lumbosacral tunnel was observed in six of the seven cadavers with L5-S1 osteophytes but in only one of the 22 cadavers without such osteophytes (P < 0.05, chi2 test). All four patients had neurologic deficits in the L5 nerve root distribution. MRI and myelography showed no abnormal findings in the spinal canal, but CAT scans demonstrated prominent osteophytes on the lateral margins of L5-S1 vertebral bodies in all four. Selective L5 nerve block completely relieved all patients of pain but only temporarily. Three patients were treated via a posterior approach by resecting the sacral ala along the L5 spinal nerve, and the other patient was treated by laparoscopic anterior resection of the osteophytes. pain relief was obtained in the four patients immediately after surgery, but one patient experienced recurrence of pain 1 year after the first surgery and was successfully treated by additional posterior decompression and fusion. CONCLUSIONS: Extraforaminal entrapment of L5 spinal nerve in the lumbosacral tunnel can cause L5 radiculopathy, and osteophytes of L5-S1 vertebral bodies are a major cause of the entrapment.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/41. Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy.To evaluate the morphologic changes of the spinal cord in patients with cervical myelopathy due to cervical spondylosis and ossification of the posterior longitudinal ligament, the authors measured the thickness and signal intensity of the cervical cord with magnetic resonance imaging in healthy adults and patients with cervical myelopathy, and compared these findings. In patients with cervical myelopathy, the preoperative and postoperative magnetic resonance imaging findings were compared with the severity of myelopathy and postoperative results. In healthy adults, the anteroposterior diameter of the cervical cord was 7.8 mm at the C3 level and decreased at lower levels. In the patients with cervical myelopathy, the preoperative spinal anteroposterior diameter was significantly reduced at various levels corresponding to the stenosis site within the vertebral canal. In the group with ossification of the posterior longitudinal ligament, the minimal anteroposterior diameter of the cervical cord tended to decrease with increasing severity of myelopathy. However no relationship was observed between the two parameters in the cervical spondylotic myelopathy group. In the group with ossification of the posterior longitudinal ligament, surgical results were good when the postoperative anteroposterior diameter was increased, whereas in the cervical spondylotic myelopathy group there was no relationship between the two parameters. In the patients with myelopathy, a high intensity area was observed in about 40% of all patients before operation and about 30% after operation. However, the presence or absence of a high intensity area did not correlate with the severity of myelopathy or with surgical results in the group with ossification of the posterior longitudinal ligament and the cervical spondylotic myelopathy groups.- - - - - - - - - - ranking = 4keywords = ligament (Clic here for more details about this article) |
5/41. An unusual cause of difficult intubation in a patient with a large cervical anterior osteophyte: a case report.This report describes a case in which a large anterior osteophyte on the C2 and C3 vertebrae, due to ankylosing spondylitis, resulted in distortion of the anatomy of the upper airway and difficult intubation. Ankylosing spondylitis (AS) is a progressive inflammatory disease, characterized by stiffening of the joints and ligaments. Stiffness of the cervical spine, atlanto-occipital, temporomandibular and cricoarytenoid joints may cause difficult intubation (1). This report describes a case in which a large anterior osteophyte on the C2 and C3 vertebrae, associated with AS, resulted in distortion of the anatomy of the upper airway and difficult intubation.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
6/41. Anterior decompression for cervical spondylosis associated with an early form of cervical ossification of the posterior longitudinal ligament.OBJECT: The goal of this study was to determine the appropriate surgical strategy for cervical spondylosis associated with an early form of ossification of the posterior longitudinal ligament (EOPLL) of the cervical spine. methods: patients with EOPLL-associated cervical spondyosis were selected for treatment. medical records and radiographs were retrospectively reviewed. Specimens taken at the time of operation were histologically examined. There were 24 men and six women ranging in age from 39 to 74 years (mean 57.6 years). Symptoms consisted of myelopathy in 28 cases and radiculopathy in two cases. Anterior decompressive surgery was performed. The EOPLL, hypertrophy of the posterior longitudinal ligament (HPLL), and the disc-PLL complex were directly resected. The mean preoperative japan Orthopaedic association score was 12.6, and the mean postoperative score was 14.4. Histologically, EOPLL was consistent with foci of compact lamellar bone in the degenerative thickening of the PLL. CONCLUSIONS: Appropriate corpectomy should follow direct removal of EOPLL associated with HPLL compressing the spinal cord to achieve good outcomes.- - - - - - - - - - ranking = 6keywords = ligament (Clic here for more details about this article) |
7/41. Thoracic spondylosis: experience of 4 cases.Thoracic spondylosis is relatively uncommon compared to cervical or lumbar spondylosis. It may cause spinal canal stenosis and result in radiculopathy, neurogenic claudication, and most commonly, myelopathy. We present our experience in the management of 4 cases with symptomatic thoracic spondylosis. The lower thoracic spine was involved in all 4 cases. The pathological changes are almost the same as in cervical or lumbar spondylosis except that ossification of ligamenta flava is more common in thoracic spondylosis. The ossified ligamenta flava may adhere tightly to the dura mater, and therefore increase the difficulty of operation. The results of decompressive laminectomy for thoracic spondylosis were acceptable.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
8/41. Treatment of cervical spondylotic myelopathy by enlargement of the spinal canal anteriorly, followed by arthrodesis.Thirty-seven patients who had enlargement of the spinal canal anteriorly and stabilization of the spine for cervical spondylotic myelopathy were followed for an average of forty-nine months (range, twenty-eight to seventy months). myelography and computed tomographic myelography were performed preoperatively on all patients to determine the location and features of the areas of decompression. The canal was enlarged by discectomy; by subtotal corpectomy and removal of the anteromedial parts of the pedicles; or by removal of osteophytes or of the posterior longitudinal ligament, or both. Partial corpectomy and interbody arthrodesis was performed in nine patients; subtotal corpectomy, including removal of the posterior parts of the vertebral bodies and of the posterior longitudinal ligament, and strut bone-grafting, in fifteen patients; and subtotal corpectomy, with detachment of the remaining thin posterior parts of the vertebral bodies and of the posterior longitudinal ligament, and strut bone-grafting, in thirteen patients. Postoperatively, radiographic examinations, including myelography and computed tomographic myelography, were performed for thirty-six patients and magnetic resonance imaging, for twenty-eight. A satisfactory neurological result was obtained in twenty-nine patients. atrophy of the spinal cord, as seen on preoperative computed-tomographic myelograms, was predictive of an unsatisfactory result of the decompression, as was weakness of the peroneal muscles. All but one of the thirty-seven patients had improved walking ability at the most recent follow-up examination: seventeen patients improved by 1 point; fourteen, by 2 points; four, by 3 points; and one, by 4 points. The remaining patient reverted to the preoperative status after an initial improvement. The ability to walk at the interim examinations was compared with that at the most recent examination; three patients had continuing improvement, while three others had deterioration. The main cause of deterioration was new spondylotic changes associated with stenosis of the spinal canal, occurring at the level of the disc just cephalad to the fused levels. We concluded that anterior decompression followed by a secure arthrodesis should be an extensive procedure for patients who have cervical spondylotic myelopathy, as determined preoperatively from a myelogram or computed tomographic myelogram. Excision of the vertebral bodies should also be wide and should include the anteromedial parts of the pedicles. The third or fourth cervical vertebra should be included in the arthrodesis prophylactically in patients who have stenosis of the spinal canal when either of these vertebrae is adjacent to the level of fusion.- - - - - - - - - - ranking = 3keywords = ligament (Clic here for more details about this article) |
9/41. Lateral rhachotomy for thoracic spinal lesions.Capener's "Lateral Rhachotomy" was modified by additional excision of the pedicle, articular facets, part of the lamina, and a posterior half of the vertebral bodies on one side through a transpleural approach to the thoracic spine, and a retroperitoneal approach to the lumbar spine. The aim was to excise a space-occupying lesion, which exists in front of the thoracic or lumbar spinal cord, safely. This modification enable the authors to expose more than 50% of the spinal canal, and decompress it from its anterior, lateral, and posterior compressing mass. The utmost important point of this procedure is the excision of the lesion under the direct visualization of the dura. In ossification of the posterior longitudinal ligament (OPLL), the dura is usually indented by the thick bony mass, and the lesion extends over a few segment with adhesion. Using "Modified Lateral Rhachotomy," it was possible to explore three or four vertebral levels in continuity through the same skin incision. In the present report, the authors described their "Modified Lateral Rhachotomy" procedure, and reviewed the case material.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
10/41. Ankylosing hyperostosis of the spine: case report.Ankylosing hyperostosis of the spine is described as osteophytic spurs or anterior osseous bridges with thickening of the corresponding vertebral cortex. The ossification includes the ligamentum longitudinale anterius and the peripheral part of the disc. Our patient had minor complaints but at the time of consultation was symptomatic.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
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