Analysis of myelomalacia and posterior longitudinal Ligament ossification as prognostic factors in patients with cervical spondylotic myelopathy submitted to laminoplasty

Background: Cervical spondylotic myelopathy is a degenerative disease of the intervertebral disc and vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. Objective: The rationale of this study is to analyze the myelomalacia and the ossification of posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty by open-door or french-door techniques. Methods: We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-square test to analyze prognostic factors for patients’ postoperative evolution in the Nurick scale, after open-door or french-door laminoplasty. Results: The comparison between pre and postoperative showed an improvement of 71.43% of cases that did not have ligament ossification compared to 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% improvement in those with myelomalacia. Conclusion: There is a need for further studies with larger samples to expressively prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors of worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.

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The Effect of Open-Door Laminoplasty for Treatment of Acute Traumatic Cervical Spinal Cord Injury

Journal of Korean Neurotraumatology Society ◽

10.13004/jknts.2009.5.2.74 ◽

2009 ◽

Vol 5 (2) ◽

pp. 74

Author(s):

Young Ha Kim ◽

Dong Wuk Son ◽

Sung Hoon Kim ◽

Sang Weon Lee ◽

Geun Sung Song

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Open Door ◽

Cord Injury

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247. Predicting mortality following traumatic cervical spinal cord injury in the elderly

The Spine Journal ◽

10.1016/j.spinee.2019.05.262 ◽

2019 ◽

Vol 19 (9) ◽

pp. S121

Author(s):

Tom Inglis ◽

Daniel Banaszek ◽

Nathan Evaniew ◽

Dilnur Kurban ◽

Vanessa K. Noonan ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

The Elderly ◽

Cervical Spinal Cord Injury ◽

Cord Injury

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Epidemiolgy of spinal cord injury after acute odontoid fractures

Neurosurgical FOCUS ◽

10.3171/foc.2000.8.6.5 ◽

2000 ◽

Vol 8 (6) ◽

pp. 1-4 ◽

Cited By ~ 14

Author(s):

James S. Harrop ◽

Ashwini D. Sharan ◽

Gregory J. Przybylski

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Consecutive Series ◽

Cervical Canal ◽

Associated Injuries ◽

Odontoid Fractures ◽

Cord Injury ◽

Injured Patients ◽

Spinal Cord Injured

Object Cervical spinal cord injury (SCI) after odontoid fracture is unusual. To identify predisposing factors, the authors evaluated a consecutive series of patients who sustained SCI from odontoid fractures. Methods A consecutive series of 5096 admissions to the Delaware Valley Regional Spinal Cord Injury Center were reviewed, and 126 patients with neurological impairment at the C1–3 levels were identified. Seventeen patients had acute closed odontoid fractures with neurological deficit. Various parameters including demographics, mechanisms of injury, associated injuries, fracture types/displacements, and radiographic cervical canal dimensions were compared between “complete” and “incomplete” spinal cord injured–patients as well as with neurologically intact patients who had suffered odontoid fractures. There were similar demographics, mechanisms of injury, associated injuries, fracture type/displacement, and canal dimensions in patients with complete and incomplete SCIs. However, only patients with complete injury were ventilator dependent. In comparison with patients with intact spinal cords, spinal cord–injured patients were more commonly males (p = 0.011) who had sustained higher velocity injuries (p = 0.027). The computerized tomography scans of 11 of 17 neurologically impaired patients were compared with those of a random sample of 11 patients with intact spinal cords. Although the anteroposterior diameter (p = 0.028) and cross-sectional area (p = 0.0004) of the cervical spinal canal at the C–2 level were smaller in impaired patients, the displacement of the fragment was not different. Conclusions Odontoid fractures are an infrequent cause of SCI. Patients with these injuries typically are males who have smaller spinal canals and have sustained high velocity injuries.

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Triple Trouble: A case of traumatic cervical spinal cord injury in a patient with ossification of posterior longitudinal ligament and disc prolapse

Turkish Journal of Emergency Medicine ◽

10.5505/1304.7361.2015.22230 ◽

2015 ◽

Author(s):

Kosar Hussain

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Posterior Longitudinal Ligament ◽

Cervical Spinal Cord Injury ◽

Disc Prolapse ◽

Cord Injury

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High incidence of venous thromboembolism after acute cervical spinal cord injury in patients with ossification of the posterior longitudinal ligament

Journal of Spinal Cord Medicine ◽

10.1080/10790268.2020.1758385 ◽

2020 ◽

pp. 1-6

Author(s):

Nana Ichikawa ◽

Gentaro Kumagai ◽

Kanichiro Wada ◽

Hitoshi Kudo ◽

Toru Asari ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Venous Thromboembolism ◽

Cervical Spinal Cord ◽

Posterior Longitudinal Ligament ◽

Cervical Spinal Cord Injury ◽

Cord Injury ◽

High Incidence

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Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

Neurosurgical FOCUS ◽

10.3171/2016.3.focus1663 ◽

2016 ◽

Vol 40 (6) ◽

pp. E4 ◽

Cited By ~ 14

Author(s):

Li-Fu Chen ◽

Tsung-Hsi Tu ◽

Yu-Chun Chen ◽

Jau-Ching Wu ◽

Peng-Yuan Chang ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cohort Study ◽

Lower Incidence ◽

Cervical Spondylotic Myelopathy ◽

Cox Regression ◽

Posterior Longitudinal Ligament ◽

Incidence Rates ◽

Cord Injury ◽

Male Patients

OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively. METHODS This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier and Cox regression analyses were performed to compare the risk of SCI between the groups. RESULTS Between January 1, 1999, and December 31, 2013, there were 17,258 patients with CSM who were followed up for 89,003.78 person-years. The overall incidence of SCI in these patients with CSM was 2.022 per 1000 person-years. Patients who had CSM with OPLL and were conservatively managed had the highest incidence of SCI, at 4.11 per 1000 person-years. Patients who had CSM with OPLL and were surgically managed had a lower incidence of SCI, at 3.69 per 1000 person-years. Patients who had CSM without OPLL and were conservatively managed had an even lower incidence of SCI, at 2.41 per 1000 person-years. Patients who had CSM without OPLL and were surgically managed had the lowest incidence of SCI, at 1.31 per 1000 person-years. The Cox regression model demonstrated that SCIs are significantly more likely to happen in male patients and in those with OPLL (HR 2.00 and 2.24, p < 0.001 and p = 0.007, respectively). Surgery could significantly lower the risk for approximately 50% of patients (HR 0.52, p < 0.001). CONCLUSIONS Patients with CSM had an overall incidence rate of SCI at approximately 0.2% per year. Male sex, the coexistence of OPLL, and conservative management are twice as likely to be associated with subsequent SCI. Surgery is therefore suggested for male patients with CSM who also have OPLL.

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Case report of ervical myelopathy due to ossification of the posterior longitudinal ligament in association with flavum ligament ossification: MRI and CT appearance

Acta medica Lituanica ◽

10.6001/actamedica.v20i2.2696 ◽

2013 ◽

Vol 20 (2) ◽

pp. 79-83

Author(s):

Monique Boukobza ◽

Jurgita Ušinskienė ◽

Simona Letautienė

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Double Layer ◽

Spinal Canal ◽

Mixed Type ◽

Cervical Spinal Cord ◽

Asian Population ◽

Posterior Longitudinal Ligament ◽

Cord Compression ◽

Cord Injury

Background. Our objective is to analyze the cervical spinal cord damage and spinal canal stenosis due to OPLL which usually affects the cervical spine and leads to progressive myelopathy in 50–60s in Asian population; to demonstrate the mixed type OPLL and to show OPLL specific dural penetration signs: “double- layer” and “C-sign” on imaging. Materials and methods. Subacute cord compression developed over a 3-month period in a 43-year-old Japanese patient. Severe spinal canal narrowing was related to the mixed type OPLL at C3–C4 through C6–C7 associated to flavum ligament ossification at T3–T4. Lateral radiograph of the cervical spine showed intraspinal ossification, CT demonstrated specific dural penetration signs, and MRI disclosed spinal cord compression. Laminectomy at C3–C7 was performed and decompression of the spinal cord was confirmed by postoperative MRI. Conclusions. Absolute cervical stenosis and association with other diseases (like calcification of flavum ligament) predispose the patient to develop more severe deficit earlier in the clinical course. Specific CT signs, “double-layer” and “C-sign”, show dural involvement. MRI is a very useful modality to identify the precise level and extent of the spinal cord injury. OPLL must be included in the differential diagnosis of subacute cervical myelopathy.

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