Pathogenesis of myelopathy in patients with ossification of the posterior longitudinal ligament

2002 ◽  
Vol 96 (2) ◽  
pp. 168-172 ◽  
Author(s):  
Shunji Matsunaga ◽  
Makoto Kukita ◽  
Kyoji Hayashi ◽  
Reiko Shinkura ◽  
Chihaya Koriyama ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Critical Point ◽  
Clinical Symptoms ◽  
Posterior Longitudinal Ligament ◽  
Static Compression ◽  
Content Type ◽  
Dynamic Factors ◽  
The Relationship ◽  
Fine Print

Object. The goal of this study was to clarify the pathogenesis of myelopathy in patients with ossification of the posterior longitudinal ligament (OPLL) based on the relationship between static compression factors and dynamic factors. Methods. There was a total of 247 patients, including 167 patients who were conservatively followed for a mean of 11 years and 2 months and 80 patients who had myelopathy at initial consultation and underwent surgery. The changes in clinical symptoms associated with OPLL in the cervical spine were examined periodically. During the natural course of OPLL in the cervical spine, 37 (22%) of 167 patients developed or suffered aggravated spinal symptoms. All of the patients with a space available for the spinal cord (SAC) less than 6 mm suffered myelopathy, whereas the patients with an SAC diameter of 14 mm or greater did not. No correlation was found between the presence or absence of myelopathy in patients whose SAC diameter ranged from 6 mm to less than 14 mm. In patients with myelopathy whose minimal SAC diameter ranged from 6 mm to less than 14 mm, the range of motion of the cervical spine was significantly greater. Conclusions. These results indicate that pathological compression by the ossified ligament above a certain critical point may be the most significant factor in inducing myelopathy, whereas below that point dynamic factors may be largely involved in inducing myelopathy.

Magnetic resonance imaging findings in ossification of the posterior longitudinal ligament of the cervical spine

1998 ◽  
Vol 88 (2) ◽  
pp. 247-254 ◽  
Author(s):  
Izumi Koyanagi ◽  
Yoshinobu Iwasaki ◽  
Kazutoshi Hida ◽  
Hiroyuki Imamura ◽  
Hiroshi Abe
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Posterior Longitudinal Ligament ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Disc Protrusion ◽  
Content Type ◽  
Fine Print

Object. Because of the lack of magnetic resonance (MR) signal from cortical bones, MR imaging is inadequate for diagnosing ossified lesions in the spinal canal. However, MR imaging provides important information on spinal cord morphology and associated soft-tissue abnormality. The purpose of this study is to determine the role of MR imaging in the diagnosis and treatment of patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. Methods. The authors reviewed MR imaging findings in 42 patients with cervical OPLL who were examined with a superconducting MR imaging system. The types of OPLL reviewed included eight cases of continuous, 21 cases of segmental, and 13 cases of the mixed type. All patients were treated surgically either by anterior (26 cases) or posterior decompression (16 cases). Conclusions. The T1-weighted images clearly demonstrated the spinal cord deformity caused by OPLL. Associated disc protrusion was found to be present at the maximum compression level in 60% of the patients in this series. The highest incidence of disc protrusion (81%) was found in patients with segmental OPLL. Intramedullary hyperintensity on T2*-weighted imaging was noted in 18 patients (43%). The neurological deficits observed in these 18 patients were significantly more severe than those observed in the other 24 patients. Postoperative MR imaging revealed improvement in the spinal cord deformity, although the intramedullary hyperintensity was still observed in most cases. The present study demonstrates the importance of associated disc protrusion in the development of myelopathy in patients with cervical OPLL. Magnetic resonance imaging findings may be used to help determine the actual levels of spinal cord compression and to suggest the method of surgical treatment.

Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine

2004 ◽  
Vol 1 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Yuto Ogawa ◽  
Yoshiaki Toyama ◽  
Kazuhiro Chiba ◽  
Morio Matsumoto ◽  
Masaya Nakamura ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Long Term Results ◽  
Open Door ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

Object. Numerous surgical procedures have been developed for treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, and these can be performed via three approaches: anterior, posterior, or combined anterior—posterior. The optimal approach in cases involving OPLL-induced cervical myelopathy, however, remains controversial. To address this issue, the authors assessed the benefits and limitations of expansive open-door laminoplasty for OPLL-related myelopathy by evaluating mid- and long-term clinical results. Methods. Clinical results obtained in 72 patients who underwent expansive open-door laminoplasty between 1983 and 1997 and who were followed for at least 5 years were assessed using the Japanese Orthopaedic Association (JOA) scoring system. The mean preoperative JOA score was 9.2 ± 0.4; at 3 years postoperatively, the JOA score was 14.2 ± 0.3 and the recovery rate (calculated using the Hirabayashi method) was 63.1 ± 4.5%, both having reached their highest level. These favorable results were maintained up to 5 years after surgery. An increase in cervical myelopathy due to progression of the ossified ligament was observed in only two of 30 patients who could be followed for more than 10 years. Severe surgery-related complications were not observed. Preoperative JOA score, age at the time of surgery, and duration between onset of initial symptoms and surgery affected clinical results. Conclusions. Mid-term and long-term results of expansive open-door laminoplasty were satisfactory. Considering factors that affected surgical results, early surgery is recommended for OPLL of the cervical spine.

Calcifying pseudoneoplasms of the spine with myelopathy

2000 ◽  
Vol 93 (2) ◽  
pp. 291-293 ◽  
Author(s):  
Matthew T. Mayr ◽  
Stephen Hunter ◽  
Scott C. Erwood ◽  
Regis W. Haid
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Thoracic Spine ◽  
Radiological Evaluation ◽  
Pathological Findings ◽  
Content Type ◽  
Progressive Myelopathy ◽  
Fine Print

✓ The authors describe two cases of calcifying pseudoneoplasms, rare degenerative lesions that mimic tumor or infection. One case involved the cervical spine and the second the thoracic spine. Both patients experienced progressive myelopathy from extradural compression of the spinal cord. The radiological evaluation, pathological findings in the lesions, treatment, and follow up are described. Total or subtotal excision can relieve symptoms and prevent recurrence of this lesion.

Atlanto-axial rotational limitation secondary to osteoid osteoma of the axis

1989 ◽  
Vol 70 (1) ◽  
pp. 129-131 ◽  
Author(s):  
Michael N. Bucci ◽  
John A. Feldenzer ◽  
William A. Phillips ◽  
Stephen S. Gebarski ◽  
Robert C. Dauser
Keyword(s):  
Cervical Spine ◽  
Physical Therapy ◽  
Osteoid Osteoma ◽  
Unusual Case ◽  
Clinical Symptoms ◽  
Transoral Approach ◽  
Content Type ◽  
Microsurgical Resection ◽  
Fine Print

✓ An unusual case of atlanto-axial rotational limitation secondary to an osteoid osteoma of the axis is presented. Transoral microsurgical resection followed by physical therapy improved the clinical symptoms. This case illustrates several unique problems within the cervical spine as well as the efficacy of the transoral approach to the axis.

Congenital neural abnormalities presenting with mirror movements in a patient with Klippel-Feil syndrome

1983 ◽  
Vol 59 (5) ◽  
pp. 891-894 ◽  
Author(s):  
Ian R. Whittle ◽  
Michael Besser
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Posterior Fossa ◽  
Pyramidal Tract ◽  
Cervical Spinal Cord ◽  
Content Type ◽  
Mirror Movements ◽  
Posterior Fossa Cyst ◽  
Vertebral Anomalies ◽  
Fine Print

✓ A young girl with Klippel-Feil syndrome presented with the onset of mirror movements in early childhood. Computerized tomography studies of her cervical spine and brain revealed fibrous diastematomyelia with duplication of the cervical spinal cord and an extra-axial midline posterior fossa cyst, together with the multiple cervical vertebral anomalies. Exploration of the posterior fossa lesion revealed it to be a dermoid cyst. The congenital spinal and cord abnormalities found in this case support the hypothesis that the Klippel-Feil syndrome may be associated with variable duplication of the spinal cord and that mirror movements may be related to impairment of pyramidal tract decussation.

Chondroma of the cervical spine

1987 ◽  
Vol 66 (1) ◽  
pp. 128-130 ◽  
Author(s):  
Gérald Lozes ◽  
Ahmad Fawaz ◽  
Harry Perper ◽  
Philippe Devos ◽  
Pascal Benoit ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Spinal Cord Compression ◽  
Vertebral Column ◽  
Cord Compression ◽  
Neurological Recovery ◽  
Surgical Removal ◽  
Content Type ◽  
Fine Print

✓ The authors report a case of cervical chondroma presenting with a syndrome of spinal cord compression in a 76-year-old woman. Total surgical removal of the lesion was followed by partial neurological recovery. Chondromas of the vertebral column are rarely reported in the literature.

Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament

1987 ◽  
Vol 67 (3) ◽  
pp. 349-357 ◽  
Author(s):  
Griffith R. Harsh ◽  
George W. Sypert ◽  
Philip R. Weinstein ◽  
Donald A. Ross ◽  
Charles B. Wilson
Keyword(s):  
United States ◽  
Cervical Spine ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Posterior Longitudinal Ligament ◽  
Japanese Patients ◽  
The United States ◽  
Content Type ◽  
Canal Diameter ◽  
Operative Planning ◽  
Fine Print

✓ Ossification of the posterior longitudinal ligament (OPLL) is a well-documented cause of cervical spine stenosis and myelopathy among Japanese patients. Reports of OPLL in North Americans are rare. Choices of diagnostic method and treatment for this entity remain controversial. The authors report the results of management of 20 patients in the United States with symptomatic OPLL of the cervical spine. These represented 10% to 20% of patients operated on over the last 3 years for myelopathy secondary to structural spinal compression. Most of these OPLL patients were Caucasian (60%), male (male:female 4:1), and middle-aged (median age 47.5 years). Six had previously undergone laminectomy or discectomy. Cervical roentgenograms and standard myelography occasionally suggested the diagnosis. Axial computerized tomography (CT) metrizamide myelography with small interslice intervals proved invaluable for diagnosis and operative planning. Magnetic resonance imaging was not necessary for diagnosis. Retrovertebral calcification extended over one to five bodies (mean 2.75). The mass ranged in size from 5 to 16 mm in anteroposterior diameter and reduced the residual canal diameter to a mean (± standard deviation) caliber of 9.42 ± 2.41 mm (mean narrowing ratio 0.44 ± 0.12). Anterior cervical decompression by medial corpectomy and discectomy with fusion uniformly reduced preoperative myelopathy. Complications were limited to transient neurological deterioration in two patients, recurrent laryngeal nerve palsy in one, and halo device pin site infections in two. At a mean postoperative interval of 15 months, improvement was seen in each category of deficit: extremity weakness, hypesthesia, hypertonia, and urinary dysfunction. All fusions produced solid unions. It is concluded that OPLL of the cervical spine is an unexpectedly prevalent cause of myelopathy among patients treated in the United States. Thin-section axial CT metrizamide myelography with small interslice intervals is essential for the investigation of patients who may have OPLL. Anterior decompression and stabilization by medial corpectomy, discectomy, removal of the calcified mass, and fusion is a safe and effective method of treatment.

Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up

2002 ◽  
Vol 96 (2) ◽  
pp. 180-189 ◽  
Author(s):  
Motoki Iwasaki ◽  
Yoshiharu Kawaguchi ◽  
Tomoatsu Kimura ◽  
Kazuo Yonenobu
Keyword(s):  
Cervical Spine ◽  
Recovery Rate ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deterioration ◽  
Cervical Laminoplasty ◽  
Content Type ◽  
Younger Age ◽  
Fine Print

Object. The authors report the long-term (more than 10-year) results of cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine as well as the factors affecting long-term postoperative course. Methods. The authors reviewed data obtained in 92 patients who underwent cervical laminoplasty between 1982 and 1990. Three patients were lost to follow up, 25 patients died within 10 years of surgery, and 64 patients were followed for more than 10 years. Results were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate was calculated using the Hirabayashi method. The mean neurological recovery rate during the first 10 years after surgery was 64%, which declined to 60% at the last follow-up examination (mean follow up 12.2 years). Late neurological deterioration occurred in eight patients (14%) from 5 to 15 years after surgery. The most frequent causes of late deterioration were degenerative lumbar disease (three patients), thoracic myelopathy secondary to ossification of the ligamentum flavum (two patients), or postoperative progression of OPLL at the operated level (two patients). Postoperative progression of the ossified lesion was noted in 70% of the patients, but only two patients (3%) were found to have related neurological deterioration. Additional cervical surgery was required in one patient (2%) because of neurological deterioration secondary to progression of the ossified ligament. The authors performed a multivariate stepwise analysis, and found that factors related to better clinical results were younger age at operation and less severe preexisting myelopathy. Younger age at operation, as well as mixed and continuous types of OPLL, was highly predictive of progression of OPLL. Postoperative progression of kyphotic deformity was observed in 8% of the patients, although it did not cause neurological deterioration. Conclusions. When the incidence of surgery-related complications and the strong possibility of postoperative growth of OPLL are taken into consideration, the authors recommend expansive and extensive laminoplasty for OPLL.

Trauma-induced myelopathy in patients with ossification of the posterior longitudinal ligament

2002 ◽  
Vol 97 (2) ◽  
pp. 172-175 ◽  
Author(s):  
Shunji Matsunaga ◽  
Takashi Sakou ◽  
Kyoji Hayashi ◽  
Yasuhiro Ishidou ◽  
Masataka Hirotsu ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Posterior Longitudinal Ligament ◽  
Radiographic Findings ◽  
Content Type ◽  
Preventive Surgery ◽  
Kaplan Meier ◽  
History Of ◽  
Interview Survey ◽  
Fine Print

Object. In these prospective and retrospective studies the authors evaluated trauma-induced myelopathy in patients with ossification of the posterior longitudinal ligament (OPLL) to determine the effectiveness of preventive surgery for this disease. Methods. The authors studied 552 patients with cervical OPLL, including 184 with myelopathy at the time of initial consultation and 368 patients without myelopathy at that time. In the former group of 184 patients retrospective analysis was performed using an interview survey to ascertain the relationship between onset of myelopathy and trauma. In the latter group of 368 patients prospective examination was conducted by assessing radiographic findings and noting changes in clinical symptoms apparent during regular physical examination. The follow-up period ranged from 10 to 32 years (mean 19.6 years). In the retrospective investigation, 24 patients (13%) identified cervical trauma as the trigger of their myelopathy. In the prospective investigation, 70% of patients did not develop myelopathy over a follow-up period greater than 20 years (determined using the Kaplan—Meier method). Of the 368 patients without myelopathy at the time of initial consultation, only six patients (2%) subsequently developed trauma-induced myelopathy. Types of ossification in patients who developed trauma-induced myelopathy were primarily a mixed type. All patients in whom stenosis affected 60% or greater of the spinal canal developed myelopathy regardless of a history of trauma. Conclusions. Preventive surgery prior to onset of myelopathy is unnecessary in most patients with OPLL.

Mechanism of the spinal cord injury and the cervical spondylotic myelopathy: new approach based on the mechanical features of the spinal cord white and gray matter

2003 ◽  
Vol 99 (3) ◽  
pp. 278-285 ◽  
Author(s):  
Kazuhiko Ichihara ◽  
Toshihiko Taguchi ◽  
Itsuo Sakuramoto ◽  
Shunichi Kawano ◽  
Shinya Kawai
Keyword(s):  
Mechanical Properties ◽  
Spinal Cord ◽  
Stress Distribution ◽  
Gray Matter ◽  
Clinical Symptoms ◽  
Cervical Spinal Cord ◽  
Strain Rates ◽  
Content Type ◽  
Cord Injury ◽  
Fine Print

Object. The authors have previously investigated the mechanical properties of the white and gray matter in the bovine cervical spinal cord, demonstrating that the gray matter is more rigid, although more fragile, than the white matter. In the present study they conducted additional tensile tests on the bovine cervical spinal cord by changing strain levels and strain rates applied to the white and gray matter. Methods. Based on their testing, the authors found the following: 1) Stress within the spinal cord relaxes over time. 2) Intracord stress is related to the strain rates or levels. The finite element method was used to compute the stress distribution within the spinal cord under three compressive loading conditions. Results from the computations showed a different stress distribution in the white and gray matter, where the distribution of stress varied with strain rate, compression volume, and the position of compression. Conclusions. These differences in mechanical properties between the white and gray matter constitute different mechanisms contributing to the development of tissue damage and clinical symptoms.

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