1/10. Treatment of cervical compressive myelopathy with a new dorsolateral decompressive procedure.OBJECT: A new dorsolateral decompressive procedure involving a unilateral approach has been devised for the treatment of cervical compressive myelopathy. In this operation, the posterior spinal elements of the contralateral side are not disturbed, and thus, postoperative deformity of the cervical spine can be avoided. Following decompressive surgery via the unilateral approach, the cervical spine was kept more stable compared with the results obtained after wide laminectomy or other expansive laminoplasty procedures. methods: Twenty-six patients underwent dorsolateral decompressive surgery, and the patients' clinical and radiological results were examined during the follow-up period to evaluate neurological function and postoperative deformities of the cervical spine. The underlying conditions for myelopathy were cervical spondylosis (19 patients), ossification of posterior longitudinal ligament (three patients), and ossification of yellow ligament (four patients). The follow-up period ranged from 6 to 110 months (average 35.5 months). Functional recovery, which was rated by using the Japanese Orthopaedic association scoring system, was an average of 56% in all patients (100% being equal to full recovery). The recovery rate was compatible with those attained after other expansive laminoplasty procedures. Radiographically, progression to swan-neck or kyphotic deformity was not observed in any patient. No postoperative spinal instability was noted. Based on computerized tomography myelograph evaluation, the average transectional area of the dural tube at the C4-5 level was expanded from 122 mm2 to 169 mm2, and the transectional area of the spinal cord at the C4-5 level was expanded from 39.6 mm2 to 52.9 mm2 after surgery. CONCLUSIONS: The authors conclude that this operative procedure could be used as a new option for the treatment of cervical compressive myelopathy.- - - - - - - - - - ranking = 1keywords = yellow (Clic here for more details about this article) |
2/10. 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 = 5keywords = yellow (Clic here for more details about this article) |
3/10. Thoracic myelopathy due to enlarged ossified yellow ligaments. Case report and review of the literature.Enlarged ossified yellow ligaments are a rare and poorly understood cause of thoracic myelopathy. The authors report the case of a patient in whom thoracic myelopathy was caused by enlarged ossified yellow ligaments.- - - - - - - - - - ranking = 6keywords = yellow (Clic here for more details about this article) |
4/10. Ossification of the yellow ligament causing thoracic cord compression.Ossification of the yellow ligament (OYL) is not infrequent in the cervical and lumbar regions but is very rare in the thoracic spine, with no more than 40 cases reported in the literature. We describe a 50-year-old male with progressive paraparesis and sensory dysfunction, secondary to OYL at T10-T11, studied by computed tomography (CT) and magnetic resonance imaging (MRI). Decompressive laminectomy and removal of the ligament resulted in marked clinical improvement. patients with OYL may initially develop sensory dysfunction associated with leg weakness. This pathological entity can be well defined by CT and MRI, and surgery by decompressive laminectomy is advised for all cases. The OYL should be removed both posteriorly and laterally to the dural sac to obtain sufficient decompression of the spinal canal.- - - - - - - - - - ranking = 5keywords = yellow (Clic here for more details about this article) |
5/10. 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 = 2keywords = yellow (Clic here for more details about this article) |
6/10. Intraspinal leakage of bone cement after vertebroplasty: a report of 3 cases.We report 3 cases of vertebroplasty-induced intraspinal leakage of bone cement that were referred to us for management. Two patients received decompressive surgery, and one received rehabilitation. The gross surgical finding of yellowish dura mater and intradural fibrosis, adhesion, and microscopic finding of arachnoid membrane fibrosis are suggestive of late effect of thermal injury. These patients had residual lower extremity weakness and urinary and stool problems 13 months, 3 years, and 4.75 years post-vertebroplasty, respectively.- - - - - - - - - - ranking = 1keywords = yellow (Clic here for more details about this article) |
7/10. 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 = 4keywords = yellow (Clic here for more details about this article) |
8/10. Myelopathy due to thickened ligamenta flava and abnormal fibrous tissue of the cervicothoracic junction--case report.A 49-year-old female with subacute myelopathic symptoms due to thickened cervicothoracic yellow ligament and abnormal epidural fibrous tissue is reported. myelography showed a complete block at the Th3 level. magnetic resonance imaging demonstrated an extra-axial mass lesion in the spinal canal at the cervicothoracic junction causing the spinal cord compression. laminectomy with resection of the lesion resulted in good neurological recovery. Histological examination revealed a thickened ligamenta flava and abnormal epidural fibrous tissue without calcification foci.- - - - - - - - - - ranking = 1keywords = yellow (Clic here for more details about this article) |
9/10. Long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to the magnetic resonance imaging findings in 52 cases.A series of 151 patients with cervical spondylotic myelopathy (CSM) were surgically treated through an anterior approach in the period from 1960 to 1987. Particular attention was given to the results of the 52 patients who were operated on more than 12 years ago. Satisfactory short-term results were obtained in all but the few who had incomplete decompression. In these patients, function deteriorated within five years. A disturbing incidence of progression of myelopathy was noted ten years after surgery. magnetic resonance imaging identified many of the causes (e.g., newly developed intervertebral disk herniation and progression of spondylosis associated with spinal malalignment in both cephalad and caudal directions). Other adverse changes were hypertrophy of the yellow ligament and ossification of the posterior longitudinal ligament. The new and improved techniques consist of decompression to a width of 16 mm or more with intraoperative ultrasonography in addition to extirpation of the posterior longitudinal ligament. This new measure may reduce the incidence of late neurologic deterioration.- - - - - - - - - - ranking = 1keywords = yellow (Clic here for more details about this article) |
10/10. Surgical treatment for ossification of the posterior longitudinal ligament and the yellow ligament in the thoracic and cervico-thoracic spine.This study analyzed the postoperative results of surgical treatment for thoracic and cervicothoracic myelopathy caused by ossification of the posterior longitudinal ligaments (OPLL) or ossification of the yellow ligaments (OYL) in 22 patients using magnetic resonance imaging (MRI), myelography and computed tomography (CT). Anterior procedures were performed in 11 patients for OPLL, while posterior approaches were adopted for the management of 11 patients for both OYL and OPLL combined with OYL lesions. Clinical symptoms were improved using both anterior and posterior techniques. MRI and myelo-CT studies, which show the direction of cord compression, the form and extent of the lesion, and the degree of thoracic kyphosis, are very useful when the surgical procedure for OPLL and OYL in the thoracic and cervico-thoracic spine is selected.- - - - - - - - - - ranking = 5keywords = yellow (Clic here for more details about this article) |
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