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Lin Y, Rao S, Liu B, Sun Y, Zhao S, Su G, Chen S, Li Y, Chen B. Percutaneous full endoscopic C1 laminectomy for developmental atlantal stenosis with myelopathy: a case report of three cases and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:720. [PMID: 35845524 PMCID: PMC9279768 DOI: 10.21037/atm-22-2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
Background Developmental atlantal stenosis with myelopathy (DASM) in adults is a rare disease that only sporadic cases have been reported over the years. C1 laminectomy (C1L) is one of the most common operations for its treatment. However, as an open surgery, it has shortcomings such as large trauma and slow postoperative rehabilitation, and minimally invasive spine surgery (MISS) offers alternative treatment options with advantages. MISS instruments expand the technical capabilities of surgeons, which allows safer and more effective therapeutics for difficult and complicated diseases. This case report presents a new minimally invasive approach; percutaneous full endoscopic C1 laminectomy (PFEC1L), for the treatment of DASM, and to consolidate the current literature on the condition to summarize its etiologies, clinical manifestations, diagnostic criteria, surgical management, and prognoses. Case Description The patient in Case 1 presented with neck pain and numbness and weakness in the limbs. The patient in Case 2 presented with numbness in the extremities and the patient in Case 3 presented with bilateral hand numbness and left lower limb weakness. They were all diagnosed with DASM and underwent PFEC1L treatment to maintain the enlargement and decompression of the atlantal canal, which achieved favorable outcomes without complications during the postoperative follow-up visit. Conclusions DASM is rare but potentially dangerous. Its diagnosis is made based on clinical manifestations combined with radiological imaging examinations, especially computed tomography (CT) scan and magnetic resonance imaging (MRI). While C1L is the most common surgical method, PFEC1L is a new feasible and safe therapeutic option with comparable good outcomes and the advantage of being minimally-invasive. To our knowledge this is the first report that PFEC1L was applied for DASM treatment.
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Affiliation(s)
- Yongpeng Lin
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyuan Rao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bingxin Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueli Sun
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuai Zhao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoyi Su
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shudong Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongjin Li
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bolai Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
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Sohn S, Chung CK, Han I, Park SB, Kim H. Increased Bone Mineral Density in Cervical or Thoracic Diffuse Idiopathic Skeletal Hyperostosis (DISH): A Case-Control Study. J Clin Densitom 2018; 21:68-74. [PMID: 27712986 DOI: 10.1016/j.jocd.2016.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/08/2016] [Indexed: 11/22/2022]
Abstract
We aim to compare the bone mineral density (BMD) in a group of patients with cervical or thoracic diffuse idiopathic skeletal hyperostosis (DISH) with that in a matched control group. We also investigated the prevalence of osteoporosis in the two groups and determined the correlation between BMD and the extent of spinal DISH. From 1999 to July 2015, 65 patients with DISH underwent dual-energy X-ray absorptiometry at our institute. The control group was matched with regard to age, sex, and body mass index to the patient group on a 1:1 basis. BMD was measured at the lumbar spine (L1-L4), femur neck, and femur total areas using dual-energy X-ray absorptiometry. The BMDs of the DISH and control groups were significantly different at the lumbar spine (L1-L4) and the femur neck (p = 0.005, 0.001). The rates of patients with osteopenia and osteoporosis were lower in the DISH than in the control group for the lumbar spine (L1-L4) (p = 0.05). A positive correlation was observed between the lumbar spine (L1-L4) BMD and the number of spine levels affected by DISH (p = 0.04). The BMDs of the lumbar spine and femur neck were found to be higher in the DISH group than in a matched control group, when patients with lumbar DISH involvement were excluded. The rates of osteopenia and osteoporosis tended to be lower in the DISH group than in the control group. Lumbar spine BMD is significantly correlated with the number of spine levels affected by DISH.
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Affiliation(s)
- Seil Sohn
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Suwon, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
| | - Inbo Han
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Suwon, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyejin Kim
- Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Li H, Zhou X, Chen G, Li F, Zhu J, Chen Q. Radiological manifestations and surgical outcome of combined upper cervical cord compression and cervical ossification of the posterior longitudinal ligament with a minimum 2-year follow-up. Medicine (Baltimore) 2017; 96:e8332. [PMID: 29137014 PMCID: PMC5690707 DOI: 10.1097/md.0000000000008332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Combined upper cervical cord compression associated with cervical ossification of the posterior longitudinal ligament (OPLL) is a rare and under-recognized disorder. The aim of this study was to investigate the radiological manifestations and surgical outcome of this combined disease.Between May 2011 and July 2015, patients who underwent surgery for combined upper cervical cord compression and cervical OPLL in our institution were included in this study. After a minimum 2-year follow-up, radiological and clinical data were collected. The etiology of upper cervical cord compression and radiological features of cervical OPLL was determined. Surgical outcome was evaluated with Visual Analogue Scale (VAS), Japanese Orthopedic Association score (JOA), space available for the spinal cord (SAC) at the cephalad adjacent level, occupying ratio of OPLL and cervical lordosis.In total, 24 patients (11 men and 13 women) with a mean age of 57.9 years old were included. The etiology of upper cervical cord compression included craniovertebral junction deformity (n = 10), atlantoaxial subluxation (n = 5), and OPLL extending to C2 level (n = 9). The extent, type, and thickest level of cervical OPLL varied among the patients. Significant improvement of VAS and JOA score was noted postoperatively and at a minimum 2-year follow-up. The result was satisfactory in SAC at the cephalad level and occupying ratio of OPLL. There were no significant differences in C2/C7 lordotic angle at the preoperative, postoperative and the last follow-up examination.In conclusion, the radiological manifestations of combined upper cervical cord compression and cervical OPLL varied among the patients. Satisfied results can be achieved with adequate surgical treatment a minimum 2-year follow-up.
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Affiliation(s)
- Hao Li
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiaopeng Zhou
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Gang Chen
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Fangcai Li
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Junfeng Zhu
- Department of Orthopedics, Suichang People's Hospital, Lishui, P.R. China
| | - Qixin Chen
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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4
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Combined upper cervical canal stenosis and cervical ossification of the posterior longitudinal ligament resulting in myelopathy: A case series and literature review. J Clin Neurosci 2017; 45:270-275. [DOI: 10.1016/j.jocn.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/09/2017] [Accepted: 08/06/2017] [Indexed: 11/22/2022]
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5
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Ding C, Gong Q, Hong Y, Wang BY, Liu H. Cervical Disc Arthroplasty Combined with Interbody Fusion for the Treatment of Cervical Myelopathy with Diffuse Idiopathic Skeletal Hyperostosis: A Case Report. Chin Med J (Engl) 2017; 129:1877-9. [PMID: 27453242 PMCID: PMC4976581 DOI: 10.4103/0366-6999.186628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Chen Ding
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Quan Gong
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ying Hong
- Operation Room, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Bei-Yu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Niu CC, Lin SS, Yuan LJ, Chen LH, Yang CY, Chung AN, Lu ML, Tsai TT, Lai PL, Chen WJ. Correlation of blood bone turnover biomarkers and Wnt signaling antagonists with AS, DISH, OPLL, and OYL. BMC Musculoskelet Disord 2017; 18:61. [PMID: 28153008 PMCID: PMC5290649 DOI: 10.1186/s12891-017-1425-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/23/2017] [Indexed: 12/17/2022] Open
Abstract
Background Wnt signaling plays an important role in development and maintenance of many organs and tissues. The most-studied secreted Wnt inhibitors are sclerostin (SOST), Dickkopf-related protein 1 (DKK-1), and secreted frizzled related protein 1 (SFRP-1) which play important roles in bone turnover. The present study investigated the relationship between serum Wnt inhibitors and diseases with excessive ossification structures, such as ossification of posterior longitudinal ligament (OPLL), ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), and ossification of yellow ligament (OYL). Methods Twenty-five patients with AS, DISH, OPLL, or OYL were recruited in this study. Fasting peripheral blood samples were collected from all patients and nine controls. Various biomarkers of bone turnover including osteocalcin (OSC), osteoprotegerin (OPG), SFRP-1, DKK-1, and SOST were investigated. Results Our data showed that serum levels of OSC were higher, but Dkk-1 levels were lower in AS, DISH, OPLL, and OYL patients than those in the controls. Serum levels of SFRP-1 were significantly higher in DISH patients than those in the controls. Serum levels of SOST were significantly higher in DISH and OPLL patients than both levels in the controls. Serum levels of OPG were lower in AS patients than those in the controls. Serum levels of OSC were higher in the OPLL patients than those in the AS patients. Serum levels of DKK-1, SFRP-1, SOST, and OPG were not significantly different between the different disease groups. Conclusions In this exploratory study, both OSC and DKK-1 levels are correlated with the clinical conditions associated with excessive ossification, indicating that blood OSC and DKK-1 levels may serve as diagnostic biomarkers for AS, DISH, OPLL, and OYL. These findings may also help discover potential drug therapies for management of these diseases in the future.
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Affiliation(s)
- Chi-Chien Niu
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No 5, Fu-Hsing Street 333, Taoyuan, Taiwan.
| | - Song-Shu Lin
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Li-Jen Yuan
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopaedic, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lih-Huei Chen
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chuen-Yung Yang
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - An-Ni Chung
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Meng-Ling Lu
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Jer Chen
- Department of Orthopaedic, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
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Liu H, Wang T, Wang H, Ding WY. Posterior decompression and internal fixation in treatment of hypertrophy of posterior longitudinal ligament at C1-2 level accompanied with lower cervical spinal stenosis: A case report. Medicine (Baltimore) 2016; 95:e5600. [PMID: 27977597 PMCID: PMC5268043 DOI: 10.1097/md.0000000000005600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Hypertrophy of posterior longitudinal ligament (HPLL) at C1-2 level accompanied with lower cervical spinal stenosis is rare in clinic. No reports have described HPLL at C1-2 level accompanied with lower cervical spinal stenosis treated by posterior decompression, combined with internal fixation in 1 stage. PATIENT CONCERNS A 70-year-old Chinese female complained of numbness and paralysis in both her hands and right leg for 1.5 years; Cervical vertebra x-rays and magnetic resonance imaging revealed a HPLL at C1-2 and cervical spinal stenosis at C3-6. DIAGNOSES She was diagnosed with cervical spondylotic myelopathy (CSM). INTERVENTIONS The patient underwent posterior decompression from C1 to C5 level, and fixed with C1-2 vertebral pedicle and C3-5 lateral mass of screw. OUTCOMES One week after operation, the patient showed significant improvement in the numbness of her hands. A follow-up cervical vertebra computed tomography showed good location of internal fixation device and correction of cervical spinal stenosis. Twelve months after surgery, the patient showed improvement in preoperative clumsiness and gait disturbance, and no recurrence of the clinical symptoms occurred. LESSONS HPLL at C1-2 level accompanied with lower cervical spinal stenosis caused myelopathy is rare. Cervical posterior decompression and internal fixation is an effective treatment. The surgical outcome is satisfactory.
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Affiliation(s)
- Huan Liu
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
| | - Tao Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
| | - Hui Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
| | - Wen-Yuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
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8
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Terzi R. Extraskeletal symptoms and comorbidities of diffuse idiopathic skeletal hyperostosis. World J Clin Cases 2014; 2:422-425. [PMID: 25232544 PMCID: PMC4163763 DOI: 10.12998/wjcc.v2.i9.422] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 06/30/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily includes spinal involvement-induced pain and range of motion. Although rare, life-threatening gastrointestinal, respiratory or neurological events or severe morbidity due to bone compression on the adjacent structures may develop. There is a limited amount of data on DISH-related events in the literature. In recent years, comorbid metabolic disorders are of great interest in patients with DISH. The early diagnosis of these conditions as well as rare entities allows an effective multidisciplinary approach for the treatment of DISH. In this article, we review extraskeletal symptoms and associated comorbidities in patients with DISH.
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Decker SD, Volk HA. Dorsal vertebral column abnormalities in dogs with disseminated idiopathic skeletal hyperostosis (DISH). Vet Rec 2014; 174:632. [PMID: 24828088 DOI: 10.1136/vr.102492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Although disseminated idiopathic skeletal hyperostosis (DISH) most often affects the ventral aspect of the vertebral column, this study evaluated the occurrence, nature and clinical relevance of dorsal vertebral column abnormalities in 10 dogs with DISH for which CT or MRI and a complete neurological examination were available. Dorsal vertebral column abnormalities were present in eight dogs and included articular process hypertrophy (n=7 dogs), periarticular new bone formation (n=1), pseudoarthrosis between spinous processes (n=4) and thickening of the dorsal lamina (n=4). These dorsal vertebral abnormalities caused clinically relevant vertebral canal stenosis in six dogs and were the only cause of clinical signs in four of these dogs. Although the lumbosacral joint was not affected by DISH, these six dogs demonstrated lumbosacral vertebral canal stenosis and clinical signs of cauda equina compression, which included paraparesis (n=5 dogs), lumbosacral pain (n=4), urinary incontinence (n=4), faecal incontinence (n=1) and urinary and faecal incontinence (n=1). There is a possible association between DISH and hypertrophy of dorsal vertebral structures, potentially resulting in vertebral canal stenosis. Although these changes occurred at segments fused by DISH, they predominantly affected adjacent non-affected segments.
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Affiliation(s)
- S De Decker
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire AL97TA, UK
| | - H A Volk
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire AL97TA, UK
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10
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Takeuchi M, Wakao N, Kamiya M, Niwa A, Osuka K, Takayasu M. Upper cervical cord compression due to a C-1 posterior arch in a patient with ossification of the posterior longitudinal ligament and a kyphotic cervical spine in the protruded-head position. J Neurosurg Spine 2013; 19:431-5. [DOI: 10.3171/2013.7.spine13229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this paper the authors report the case of a patient with ossification of the posterior longitudinal ligament (OPLL) below the axial vertebra (C-2) at the kyphotic cervical spine, with an atlas vertebra (C-1) posterior arch that compressed the spinal cord with the head in a pathognomonic position, similar to a protruded position. This condition appears to be very rare. The morphological findings between the kyphotic cervical spine and OPLL, the upper occipitocervical junction, and the protruded-head position are discussed. A 40-year-old man presented with severe pain radiating to both legs when he yawned, sneezed, or extended his jaw (a protruded-head position). A kyphotic cervical spine with OPLL below C-2 was observed using CT and radiography, yet sagittal T2-weighted MRI failed to identify abnormal findings in a neutral or extension position, except for a slight cervical canal stenosis. However, in a pathognomonic protruded-head position, sagittal T2-weighted MRI showed a C-1 posterior arch that severely compressed the spinal cord at the upper cervical level. Therefore, the authors believe that the severe pain radiating to both legs was caused by a spinal canal stenosis due to a C-1 posterior arch impingement. The C-1 posterior arch was resected, and after the surgery, the patient indicated that the intolerable pain had disappeared. In conclusion, in patients with OPLL and a kyphotic cervical spine, the authors propose that the pathognomonic protruded position is valuable for estimating disrupted compensatory mechanisms at the upper cervical junction.
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Affiliation(s)
| | - Norimitsu Wakao
- 2Orthopedic Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Mitsuhiro Kamiya
- 2Orthopedic Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Aichi Niwa
- 1Departments of Neurological Surgery and
| | - Koji Osuka
- 1Departments of Neurological Surgery and
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Koizumi S, Yamaguchi-Okada M, Namba H. Myelopathy due to multilevel cervical canal stenosis with Forestier disease: case report. Neurol Med Chir (Tokyo) 2013; 50:942-5. [PMID: 21030813 DOI: 10.2176/nmc.50.942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 56-year-old woman presented with multilevel myelopathy associated with Forestier disease (FD). The patient was hospitalized for dysphagia, bilateral shoulder pain, and progressive gait disturbance. The diagnosis was confirmed by radiography and magnetic resonance imaging which demonstrated coalescent anterior osteophyte formation extending from C2 to C7 with atlanto-axial dislocation and persistence of mobility at C3-4, and a hyperintense area in the spinal cord at the C1 and C3-4 levels on T(2)-weighted images. Dynamic radiography showed no instability at the C1 and C3-4 levels. Decompressive laminectomy of the atlas, dome-like laminectomy, and facet fusion at C3-4 were performed, resulting in symptomatic improvement. Myelopathy is very rare in patients with FD and is due to mechanical stress at the level where mobility persists. Strategic intervention should be considered based on evaluation of mobile levels and stenotic lesions.
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Affiliation(s)
- Shinichiro Koizumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hmamatsu, Shizouka, Japan
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Saetia K, Cho D, Lee S, Kim DH, Kim SD. Ossification of the posterior longitudinal ligament: a review. Neurosurg Focus 2011; 30:E1. [PMID: 21434817 DOI: 10.3171/2010.11.focus10276] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, the elderly, and Asian patients. There are many diseases associated with OPLL, such as diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and other spondyloarthropathies. Several factors have been reported to be associated with OPLL formation and progression, including genetic, hormonal, environmental, and lifestyle factors. However, the pathogenesis of OPLL is still unclear. Most symptomatic patients with OPLL present with neurological deficits such as myelopathy, radiculopathy, and/or bowel and bladder symptoms. There are some reports of asymptomatic OPLL. Both static and dynamic factors are related to the development of myelopathy. Plain radiography, CT, and MR imaging are used to evaluate OPLL extension and the area of spinal cord compression. Management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be made case by case, depending on the patient's condition, level of pathology, type of OPLL, and the surgeon's experience. In this paper, the authors attempt to review the incidence, pathology, pathogenesis, natural history, clinical presentation, classification, radiological evaluation, and management of OPLL.
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Affiliation(s)
- Kriangsak Saetia
- 1Division of Neurosurgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Dosang Cho
- 2Department of Neurosurgery, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Sangkook Lee
- 3Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and
| | - Daniel H. Kim
- 3Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and
| | - Sang Don Kim
- 4Department of Neurosurgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, South Korea
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13
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Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20 Suppl 2:S195-201. [DOI: 10.1007/s00586-010-1538-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 06/26/2010] [Accepted: 07/18/2010] [Indexed: 10/19/2022]
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