Thoracic myelopathy secondary to ossification of the spinal ligament

1987 ◽  
Vol 66 (4) ◽  
pp. 511-518 ◽  
Author(s):  
Kazuo Yonenobu ◽  
Sohei Ebara ◽  
Keiju Fujiwara ◽  
Kazuo Yamashita ◽  
Keiro Ono ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Manifestations ◽  
Posterior Longitudinal Ligament ◽  
Motor Deficits ◽  
Thoracic Myelopathy ◽  
Content Type ◽  
Atypical Symptoms ◽  
Initial Improvement ◽  
Upper Thoracic ◽  
Spinal Ligament

✓ The authors describe their experience with 26 cases of thoracic myelopathy secondary to hypertrophic ossification of the spinal ligament (posterior longitudinal ligament and/or ligamentum flavum). The clinical manifestations of this condition and results of its surgical treatment are described. The commonest symptoms were numbness or tingling in the legs and feet and gait disturbance. Most of the patients with involvement of the upper thoracic spine showed typical features of thoracic myelopathy: that is, sensory and motor deficits in both the trunk and lower extremities, sphincter disturbance, and exaggerated tendon reflexes. Several patients with involvement of the thoracolumbar junction presented with atypical symptoms of thoracic myelopathy and were sometimes misdiagnosed and treated inappropriately. Surgical treatment, particularly laminectomy, was not always successful. Inconsistencies in the surgical outcome were caused by either operative complications or reversal of the initial improvement during the follow-up period. The results of anterior surgery for the condition were more favorable; however, use of this procedure was rarely indicated.

Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases

2003 ◽  
Vol 99 (2) ◽  
pp. 157-161 ◽  
Author(s):  
Karim Ben Hamouda ◽  
Hafedh Jemel ◽  
Slim Haouet ◽  
Moncef Khaldi
Keyword(s):  
North Africa ◽  
Endochondral Ossification ◽  
Ligamentum Flavum ◽  
Clinical Manifestations ◽  
Magnetic Resonance Images ◽  
Thoracic Myelopathy ◽  
Content Type ◽  
Mode Of Development ◽  
Symptoms And Signs ◽  
Fine Print

Object. Thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) is a rare entity, most evident in Japan. The authors studied the clinical manifestations, radiological aspects, surgical treatment, and pathogenesis of this disease. Methods. Eighteen patients with OLF-induced thoracic myelopathy underwent laminectomy. The severity of myelopathy varied. Complete paraplegia was seen in three cases. Compression of the upper and middle third of the thoracic spine was evident in six cases and of the lower third in 12 cases. Multilevel OLF was demonstrated in 13 cases. In most cases, the ossified ligamentum flavum appears as a V-shaped lesion on computerized tomography and magnetic resonance images. In all patients the diameter of the posterior spinal canal, already narrowed, was further exacerbated by the OLF. Laminectomy was limited to the levels of compression, and the ligamentum flavum was resected in all cases. The symptoms and signs improved in 13 cases and stabilized in four cases. In one case symptoms recurred as a result of ossified lesions forming at other sites. Histological examination showed that the mode of development of the ossified ligaments was endochondral ossification. Conclusions. Reports of OLF-induced myelopathy are rare and mainly described in Japan. The incidence also seems high in North Africa. An early laminectomy limited to the level of compression is recommended. Ossified ligamentum flavum is different from the calcification of the ligamentum flavum, which is due to crystal deposits.

scholarly journals Acromegaly presenting with myelopathy due to ossification of posterior longitudinal ligament: a case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Daisuke Kamakura ◽  
Katsunori Fukutake ◽  
Kazumasa Nakamura ◽  
Shintaro Tsuge ◽  
Keiji Hasegawa ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Posterior Longitudinal Ligament ◽  
High Serum ◽  
Posterior Fixation ◽  
Facial Features ◽  
Thoracic Myelopathy ◽  
Lower Extremity Weakness ◽  
Main Challenge ◽  
Spinal Ligament

Abstract Background Acromegaly is a rare disease caused by high serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), often originating from a pituitary adenoma. Spinal and peripheral joint abnormalities are caused by these hormonal hypersecretions. In particular, the response to GH is involved in the onset of ossification of the spinal ligament in vitro, especially ossification of the posterior longitudinal ligament (OPLL). However, because acromegaly and OPLL are rare diseases, we seldom encounter them in combination. To the best of our knowledge in the English-language literature, this is the first reported case of acromegaly presenting with thoracic myelopathy due to OPLL. Case presentation A 47-year-old woman presented with lower extremity weakness and paresthesia, gait disorder, and bladder disorder without any trauma. The patient’s most remarkable symptom was paraplegia, and we diagnosed myelopathy due to cervical and thoracic OPLL. Furthermore, we suspected acromegaly because of the characteristic facial features, and we found a pituitary adenoma by contrast-enhanced MRI. Cervical and thoracic decompression, posterior fixation, and pituitary adenoma resection were performed. Conclusion We report a case of acromegaly that was detected after the diagnosis of OPLL. The main challenge in acromegaly is delayed in diagnosis. Even in this case, the facial features characteristic of acromegaly had appeared at least 9 years ago. Early diagnosis and treatment of acromegaly improve prognosis and reduce exposure to GH and IGF-1 through early intervention and seem to suppress the progression of ligament ossification. Orthopedic surgeons and neurosurgeons need to keep in mind that acromegaly is associated with bone/joint lesions and ossification of the spinal ligament and should aim to diagnose acromegaly early.

Frontal Lobe Cavernous Malformations in Pediatric Patients: Clinical Features and Surgical Outcomes

2018 ◽  
Vol 33 (8) ◽  
pp. 512-518 ◽  
Author(s):  
Chengjun Wang ◽  
Meng Zhao ◽  
Jia Wang ◽  
Shuo Wang ◽  
Zhongli Jiang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Frontal Lobe ◽  
Clinical Manifestations ◽  
Case Series ◽  
Motor Deficits ◽  
Cavernous Malformations ◽  
Rehabilitative Treatment ◽  
Neurologic Outcomes ◽  
The Mean

The purpose of this study is to investigate the clinical manifestations, surgical treatment, and neurologic outcomes of frontal lobe cavernous malformations in children. A retrospective analysis of 23 pediatric frontal lobe cavernous malformation patients who underwent surgical treatment in Beijing Tiantan Hospital was performed. The case series included 16 boys and 7 girls. Gross total removal without surgical mortality was achieved in all patients. The mean follow-up period after surgery was 33.1 months. Two patients who left hospital with motor deficits gradually recovered after rehabilitative treatment, and other patients were considered to be in excellent clinical condition. For symptomatic frontal lobe cavernous malformations, neurosurgical management should be the treatment of choice. Conservative treatment may be warranted in asymptomatic frontal lobe cavernous malformations, especially the deep-seated or eloquently located cases.

scholarly journals Combined surgical treatment of the cerebral arteriovenous malformations in patients with the torpid course of the disease

2020 ◽  
Vol 30 (4) ◽  
pp. 38-48
Author(s):  
Yu.R. Yarotskyi ◽  
L.M. Yakovenko ◽  
M.Yu. Orlov ◽  
A.G. Lugovskyi ◽  
V.V. Moroz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformations ◽  
Clinical Course ◽  
Promising Result ◽  
Balloon Catheter ◽  
Clinical Manifestations ◽  
Intracerebral Hematoma ◽  
Motor Deficits ◽  
Cerebral Arteriovenous Malformations ◽  
Group I

Objective – to optimize the results of surgical treatment of the cerebral arteriovenous malformations (AVM) with a torpid clinical course of the disease.Materials and methods. The results of combined surgical treatment of cerebral AVMs of 36 patients without a history of AVM rupture were analyzed (this variant of clinical course was defined as «torpid»). Patients were treated in the departments of vascular neurosurgery at the Romodanov Neurosurgery Institute NAMS of Ukraine during the period from 2010 till September 2019. Among the patients there were 18 (50 %) men and 18 (50 %) women. The average age of patients was 28.1 years (10–47 years). Clinical, neurological, laboratory, instrumental, functional and morphological methods of examination were used as well as neuroimaging evaluation and follow-up investigation.Results. The «torpid» course of disease in patients with AVM was presented as heterogeneous epileptiform manifestations in 24 (66.7 %) cases. One (2.8 %) patient had seizure that were combined with internal hydrocephalus, 9 (25 %) patients had different severity cephalalgic syndrome (according to the International classification of headache – 3β). Progressive neurological deficit was detected in 2 (5.55 %) patients. The distribution of AVMs according Spetzler–Martin scale (1986) was as follows: grade I – in 2 (5.55 %) patients, grade II – in 10 (27.8 %), grade III – in 13 (36.1 %), grade IV – in 9 (25.0 %), grade V – in 2 (5.55 %). In most cases (94.44 %), AVMs were supratentorial, and in 2 (5.55 %) cases they were subtentorial. The average AVM size in the largest dimension was 3.7 cm (2.8–6.7 cm). Intranidal aneurysms in the AVM structure were diagnosed in 8 (22.2 %) patients, fistulas – in 7 (19.4 %) cases. In all cases, at the first stage, endovascular embolization (EE) of AVM was performed. All 36 patients underwent 64 endovascular procedures. Curative treatment after 1 stage was performed in 16 (44.4 %) patients, after 2 stages – in 13 (36.1%), after 3 stage – in 6 (16.66 %), and after 4 stage in 1 (2.77 %) patient. In 36 (56.25 %) cases, embolization was performed with Onyx composition (eV3), in 24 (37.5 %) – with n-butylcyanoacrylate, and in 3 (4.7 %) – with their combination. In 1 (1.56 %) patient, the fistula was excluded from the blood flow using detached balloon-catheter. Embolization was supplemented with radiosurgical treatment (RST) in 30 (83.3 %) cases, microsurgical removal – in 2 (5.55 %), radiotherapy – in 2 (5.55 %) patients. In 1 (2.77 %) case EE was combined with shunting procedure and RST. One (2.77 %) patient after EE with RST suffered hemorrhagic stroke with intracerebral hematoma formation. An operation was performed for hematoma removal and partially functioning AVM resection. In 7 (10.9 %) cases after EE of AVM, patients developed motor deficits. At the time of discharge, they regressed completely in 6 patients, and partially in 1 patient. In (1.5 %) case homonymous hemianopsia had occurred. After RST, total obliteration of AVM was achieved in 17 (58.6 %) patients, in 5 (17.2 %) – subtotal (repeated RST was recommended). In 7 (24.1 %) cases, positive signs of AVM obliteration was noted, and the timing of radiation exposure did not reach the recommended ones. In 2 (3.1 %) patients after microsurgical resection, the AVM was removed completely, which was confirmed by cerebral angiography. After radiotherapy, decreasing of the AVM size and a positive neurological dynamics were noted. There were no fatal outcomes. According to the modified Rankine scale, patients were distribution to group 0 (33 (91.7 %)) and group I (3 (8.3 %)).Conclusions. The obtained data indicate the promising result of combined surgical treatment of cerebral AVM with a torpid type of clinical manifestations. The leading technique in the applied staged combined surgical treatment of AVM was EE. Its successful use is due to the effectiveness of its impact on all components of the «complex» AVM.

Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients

2007 ◽  
Vol 7 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Toshimi Aizawa ◽  
Tetsuro Sato ◽  
Hirotoshi Sasaki ◽  
Fujio Matsumoto ◽  
Naoki Morozumi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Intervertebral Disc Herniation ◽  
Thoracic Myelopathy ◽  
Duration Of Symptoms ◽  
Factors Affecting ◽  
Age At Surgery ◽  
Postoperative Improvement

Object Thoracic myelopathy is uncommon compared with cervical myelopathy. In this study, data obtained in patients with thoracic myelopathy caused by degenerative processes of the spine were retrospectively analyzed to clarify the surgical outcomes and to examine the various factors affecting the postoperative improvement. Methods Between 1988 and 2002, 132 patients with thoracic myelopathy underwent surgery and a minimum 2-year observation period. Clinical data were collected from medical and operative records, and sagittal alignment of the spine was measured on radiographs. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors affecting the preoperative severity of myelopathy and postoperative improvement were also examined. Results The population consisted of 97 men (mean age at surgery was 58 years) and 35 women (mean age at surgery 62 years). Myelopathy was caused by ossification of the ligamentum flavum (OLF) in 73 patients, ossification of the posterior longitudinal ligament (OPLL) in 21, combined OLF–OPLL in 10, intervertebral disc herniation (IDH) in 15, posterior bone spur in 11, and OLF with IDH or posterior bone spur in one patient each. The surgical outcome was relatively good: a mean preoperative JOA score of 5.3 improved to a mean score of 7.8 at the last follow-up, 50 months on average after surgery. Thoracic myelopathy caused by OPLL, however, was associated with lower postoperative scores and recovery rates. In more than half of the patients the authors documented an increase of kyphosis of less than 2°. Conclusions Patients with a shorter preoperative duration of symptoms and milder myelopathy experienced significantly better postoperative neurological conditions, which indicated that those who present earlier with fewer disabilities should be recommended to undergo surgery in time, although the surgical treatment for OPLL still involves many problems.

Cesarean scar defects: diagnosis and treatment in non-pregnant women

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 6-10
Author(s):  
Sergey A. Martynov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Genital Tract ◽  
Conservative Therapy ◽  
Clinical Manifestations ◽  
Subsequent Pregnancy ◽  
Resonance Imaging ◽  
Diagnostic Features ◽  
Pregnancy And Childbirth

The aim of the review was to summarize information on clinical manifestations, diagnostic features, as well as methods for correction of scar defects after cesarean section (CS) outside pregnancy. Lack of the scar after CS, niche, isthmocele are a myometrium defect in the area of scar after CS, which is most often detected by ultrasound, sonohysterography or magnetic resonance imaging and is manifested by postmenstrual bleeding from the genital tract. In some cases, it can cause menorrhagia, dyspareunia, pelvic pain, infertility, uterine rupture during subsequent pregnancy and childbirth. Conservative therapy or surgical treatment with laparoscopy, laparotomy or vaginal approach is carried out depending on the symptoms, size of the defect, the thickness of the residual myometrium, as well as the womans reproductive plans.

Surgical treatment of cerebral metastases from lung cancer

1971 ◽  
Vol 35 (4) ◽  
pp. 416-420 ◽  
Author(s):  
Edwin E. MacGee
Keyword(s):  
Lung Cancer ◽  
Surgical Treatment ◽  
Operative Mortality ◽  
Cerebral Metastases ◽  
Cerebral Metastasis ◽  
Metastatic Lung Cancer ◽  
Content Type ◽  
Intracranial Surgery ◽  
Metastatic Lung ◽  
Fine Print

✓ Results in 27 cases of intracranial surgery for metastatic lung cancer are evaluated with regard to both the quality and duration of survival; 56% of the patients lived more than 1 year, with the longest survivor still living 32 months after operation. The operative mortality was 26%. These data suggest that intracranial surgery is worthwhile in patients with lung cancer when the cerebral metastasis is either solitary or single.

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