Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population

2006 ◽  
Vol 5 (6) ◽  
pp. 514-519 ◽  
Author(s):  
Toshimi Aizawa ◽  
Tetsuro Sato ◽  
Hirotoshi Sasaki ◽  
Takashi Kusakabe ◽  
Naoki Morozumi ◽  
...  
Keyword(s):  
Clinical Features ◽  
Japanese Population ◽  
Ligamentum Flavum ◽  
Correct Diagnosis ◽  
Japanese Orthopaedic Association ◽  
Thoracic Myelopathy ◽  
Duration Of Symptoms ◽  
Female Ratio ◽  
Miyagi Prefecture ◽  
The Mean

Object Data obtained in patients with thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) were retrospectively reviewed to clarify clinical features and surgical outcomes in the Japanese population. Methods Seventy-two patients who underwent surgery for OLF-induced myelopathy in the Miyagi Prefecture, Japan, between 1988 and 2002 were observed for at least 2 years. Clinical data were collected from medical and operative records. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors (age, sex, and preoperative duration of symptoms) affecting the preoperative severity of myelopathy and postoperative improvement were also examined. Conclusions In this series the surgical outcome was relatively good and depended on the severity of myelopathy; thus early and correct diagnosis is required to avoid poorer results. The male/female ratio was 3.2 and the mean patient age at surgery was 61 years for men and 68 for women. The patients commonly noticed numbness or pain in their lower legs or gait disturbances. In a total of 104 decompressed intervertebral disc levels, more than 80% of the ossified ligaments were at the T9–10 level or lower. The mean preoperative JOA score of 5.1 improved to 7.9 after an average of 46 months. The postoperative results statistically depended on the preoperative severity of myelopathy. Among studies of patients with OLF-related myelopathy, the present study had the largest sample size, which should help clarify the clinical features of OLF myelopathy.

scholarly journals Comparison of Surgical Results of the Bridge Crane Technique Versus Laminectomy for the Treatment of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

2021 ◽  
pp. 219256822199668
Author(s):  
Kaiqiang Sun ◽  
Xiaofei Sun ◽  
Jian Zhu ◽  
Fei Huang ◽  
Le Huan ◽  
...  
Keyword(s):  
Ligamentum Flavum ◽  
Demographic Data ◽  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Bridge Crane ◽  
Thoracic Myelopathy ◽  
Duration Of Symptoms ◽  
Postoperative Hematoma ◽  
Csf Leakage

Study Design: A retrospective study. Objectives: This study aimed to evaluate the safety and effectiveness of the bridge crane technique versus laminectomy for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum (OLF). Methods: Totally 41 patients who underwent surgical decompression due to thoracic OLF from May 2017 to June 2018 in our institution were enrolled in this study and were divided into group BG (bridge crane technique, n = 19) and group L (laminoectomy, n = 22). Demographic data was collected from medical records and the modified Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological outcomes during the follow-up. Surgery-related complications were analyzed. Results: The mean duration of follow-up was comparable between group BG (19.4 ± 1.5 months) and group L (19.6 ± 1.4 months). No statistical differences were observed between two groups in terms of gender, age, duration of symptoms, preoperative occupying rate, involved levels, operation time, intraoperative blood loss, and complications. The JOA score significantly increased at the final follow-up in both groups. However, patients in group BG had higher JOA score and recovery rate ( P < 0.05). Four patients in group L experienced complications, including 3 cerebrospinal fluid (CSF) leakage and one postoperative hematoma. Only one patient in group BG had CSF leakage. Conclusion: The results of this study suggested that bridge crane technique may be relatively safe and effective for patients with symptomatic thoracic OLF with more satisfactory clinical improvement. However, high-quality studies are still required to validate the results of this study.

scholarly journals Clinical profile of cardiac myxoma: 11 years’ experience of 90 cases

2016 ◽  
Vol 31 (1) ◽  
pp. 18-22
Author(s):  
Md Toufiqur Rahman ◽  
Md Zulfikar Ali ◽  
Md Humayun Kabir ◽  
STM Abu Azam ◽  
AAS Majumder ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Primary Tumour ◽  
Correct Diagnosis ◽  
Cardiac Myxoma ◽  
Benign Neoplasm ◽  
Clinical Feature ◽  
Duration Of Symptoms ◽  
Pedal Oedema ◽  
Mechanical Interference ◽  
The Mean

Introduction: Cardiac myxoma is a benign neoplasm that represents the most common primary tumour of the heart. Because of nonspecific symptoms, early diagnosis may be a challenge. Although the left atrium is the most commonly involved site of origin in 75% of cases, it can arise from any of the cardiac chambers. Symptoms from a cardiac myxoma are more pronounced when the myxomas are left-sided, racemosus, and over 5 cm in diameter. Symptoms are produced by mechanical interference with cardiac function or embolization. Being intravascular and friable, myxomas account for most cases of tumor embolism. The site of embolism is dependent upon the location (left or right atrium) and the presence of an intracardiac shunt. Most atrial myxomas are benign and can be removed by surgical resection.Objectives: To see clinical presentation and echocardiographic profile of cardiac myoxomas.Methods: 90 cardiac myxoma patients who admitted both in cardiology and cardiac surgery departments of National Institute of Cardiovascular Diseases (NICVD), Dhaka from August 2003 to July, 2014 were studied clinically and by echocardiogram. Clinical histories were reviewed, noting age, gender, and clinical presentation.Results: There were 30 males and 60 females, ages ranged from 17 to 76 years. The commonest clinical feature was dyspnoea (94.44%), followed by palpitation (76.67%), chest discomfort (74.44%), constitutional symptoms (50%), pedal oedema (20%), syncope (14.44%), and embolization (7.7%). The mean duration of symptoms was 09.7 months.Conclusion: The clinical presentation of cardiac myxoma is often nonspecific, so high index of clinical suspicion is important for its early and correct diagnosis. The size and appearance of the myxomas correlated with the presenting symptoms.Bangladesh Heart Journal 2016; 31(1) : 18-22

scholarly journals Microendoscopic Posterior Decompression for Treating Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum: Case Series

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 684
Author(s):  
Satoshi Baba ◽  
Ryutaro Shiboi ◽  
Jyunichi Yokosuka ◽  
Yasushi Oshima ◽  
Yuichi Takano ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Thoracic Spine ◽  
Rating Scale ◽  
Ligamentum Flavum ◽  
Case Series ◽  
Lumbar Spine Surgery ◽  
Thoracic Myelopathy ◽  
Posterior Decompression ◽  
Postoperative Hematoma ◽  
The Mean

Background and Objectives: Ossification of the ligamentum flavum (OLF) is a relatively common cause of thoracic myelopathy. Surgical treatment is recommended for patients with myelopathy. Generally, open posterior decompression, with or without fusion, is selected to treat OLF. We performed minimally invasive posterior decompression using a microendoscope and investigated the efficacy of this approach in treating limited type of thoracic OLF. Materials and Methods: Microendoscopic posterior decompression was performed for 19 patients (15 men and four women) with thoracic OLF with myelopathy aged between 35 to 81 years (mean age, 61.9 years). Neurological examination and preoperative magnetic resonance imaging (MRI) and computed tomography (CT) were used to identify the location and morphology of OLF. The surgery was performed using a midline approach or a unilateral paramedian approach depending on whether the surgeon used a combination of a tubular retractor and endoscope. The numerical rating scale (NRS) and modified Japanese Orthopedic Association (mJOA) scores were compared pre- and postoperatively. Perioperative complications and the presence of other spine surgeries before and after thoracic OLF surgery were also investigated. Results: Four midline and 15 unilateral paramedian approaches were performed. The average operative time per level was 99 min, with minor blood loss. Nine patients had a history of cervical or lumbar spine surgery before or after thoracic spine surgery. The mean pre- and postoperative NRS scores were 6.6 and 5.3, respectively. The mean recovery rate as per the mJOA score was 33.1% (mean follow-up period, 17.8 months), the recovery rates were significantly different between patients who underwent thoracic spine surgery alone (50.5%) and patients who underwent additional spine surgeries (13.7%). Regarding adverse events, one patient experienced dural tear, another experienced postoperative hematoma, and one other underwent reoperation for adjacent thoracic stenosis. Conclusion: Microendoscopic posterior decompression was applicable in limited type of thoracic OLF surgery including beak-shaped type and multi vertebral levels. However, whole spine evaluation is important to avoid missing other combined stenoses that may affect outcomes.

Stroke in a Subsaharan Nigerian Hospital—A Retrospective Study

1989 ◽  
Vol 19 (1) ◽  
pp. 11-14 ◽  
Author(s):  
S A Bwala
Keyword(s):  
Duration Of Symptoms ◽  
Female Ratio ◽  
Transient Ischaemic Attacks ◽  
History Of ◽  
Hospital Deaths ◽  
Insulin Dependent ◽  
The Mean ◽  
The University ◽  
First Time ◽  
Male To Female

The case records of 53 consecutive Nigerian inpatients with stroke in the University of Maiduguri Teaching Hospital, Maiduguri were retrospectively reviewed. The mean age at presentation was 55 years and the male to female ratio was 2.5: 1. The mean duration of symptoms before presentation was 11.1 weeks and the average duration of stay in hospital was 3 weeks. Thirty-three (63%) of the lesions were infarctive and 19 (37%) were haemorrhagic. Only 3 (6%) patients gave a history of prior transient ischaemic attacks (TIAs). Forty-two (79%) patients were hypertensive at presentation out of which 27 (64%) had the hypertension diagnosed for the first time. Four (8%) patients were non-insulin dependent diabetics. There were 11 hospital deaths (21%). Thus hypertension, more than half undiagnosed at admission, was the most common risk factor for stroke in the hospital population studied.

En Bloc Resection of Lamina and Ossified Ligamentum Flavum in the Treatment of Thoracic Ossification of the Ligamentum Flavum

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1181-1186 ◽  
Author(s):  
Lian-shun Jia ◽  
Xiong-sheng Chen ◽  
Sheng-yuan Zhou ◽  
Jiang Shao ◽  
Wei Zhu
Keyword(s):  
Evaluation System ◽  
Ligamentum Flavum ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Neurological Dysfunction ◽  
Thoracic Myelopathy ◽  
En Bloc ◽  
Improvement Rate ◽  
The Mean

Abstract OBJECTIVE We performed a retrospective patient chart review to determine the feasibility and safety of en bloc resection of lamina and ossified ligamentum flavum in the treatment of thoracic ossification of ligamentum flavum (OLF). METHODS From January 2000 to June 2006, 36 patients with thoracic OLF underwent en bloc resection of lamina and ossified ligamentum flavum by a burr-grinding technique. The range of resection included one lamina superior and one lamina inferior to the diseased segments. Ossified dura mater was removed if present, and simultaneous repair was carried out. RESULTS The mean preoperative Japanese Orthopedic Association (JOA) score (an evaluation system for thoracic myelopathy with a total score of 11 points) was 5 points (range, 3–9 points). The mean JOA score at the last follow-up visit (mean follow-up period, 3.9 years) was 8.44 points (range, 6–11 points). The range of improvement was from 2 to 6 points, and the mean improvement rate was 60.5% (range, 33.3%–100%). No postoperative aggravation of neurological dysfunction, leakage of cerebrospinal fluid (CSF), wound infection, kyphosis, or recurrence occurred. A CSF cyst found in one patient 3 weeks postoperatively was absorbed automatically after 10 months. CONCLUSION The en bloc resection technique described here is both safe and effective.

Postlaminoplasty cervical range of motion: early results

2007 ◽  
Vol 6 (5) ◽  
pp. 386-390 ◽  
Author(s):  
Suk-Hyung Kang ◽  
Seung-Chul Rhim ◽  
Sung-Woo Roh ◽  
Sang-Ryong Jeon ◽  
Hyun-Chul Baek
Keyword(s):  
Range Of Motion ◽  
Japanese Orthopaedic Association ◽  
Cervical Canal ◽  
Cervical Laminoplasty ◽  
Duration Of Symptoms ◽  
Cervical Range Of Motion ◽  
Curvature Index ◽  
Before And After ◽  
The Mean

Object The authors studied cervical range of motion (ROM) before and after cervical laminoplasty to determine factors associated with cervical ROM in patients with cervical myelopathy. Methods Between July 2003 and August 2005, 20 patients underwent a modified Hirabayashi-type unilateral open-door laminoplasty to treat multilevel cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL). Clinically, the authors assessed Japanese Orthopaedic Association (JOA) score, duration of symptoms, disease entity, and the age and sex of patients to ascertain the relation of these factors to ROM before and after cervical laminoplasty. Intraoperative findings such as ligament detachment from the C-2 spinous process and cervicothoracic junction involvement were noted. Radiological and imaging findings such as the length of the lesion, cervical axial canal area, antero-posterior (AP) diameter of the cervical canal, angle of the opened lamina after surgery, cervical sagittal angles, cervical curvature index (CCI), and signal change of the cord on magnetic resonance imaging were evaluated. The mean follow-up period was 19.45 months (range 13–38 months). The preoperative average ROM in 18 patients (after excluding two patients with trauma) was 36.73 ± 15.73°; postoperatively it was 25.24 ± 16.06°. Thus, ROM decreased by 9.64 ± 10.09° (31.80%) after surgery (p = 0.002), reflecting the mean in the same 18 patients. Preoperative ROM was related to the age of patients, CCI, preoperative JOA score, and AP diameter of the cervical canal. In cases of OPLL the ROM was lower than that in cases of spondylosis. Postoperative cervical ROM was related to preoperative ROM, postoperative AP diameter of the cervical canal, laminar angle, patient age, and follow-up duration. None of the studied parameters, however, correlated with a decreased cervical ROM. Conclusions Cervical ROM was reduced after cervical laminoplasty. Postlaminoplasty cervical ROM had a positive correlation with extended motion; however, gradually it became reduced. In this study, no correlative factor was associated with a reduction in cervical ROM. Further study is also needed.

Sagittal alignment changes after thoracic laminectomy in adults

2008 ◽  
Vol 8 (6) ◽  
pp. 510-516 ◽  
Author(s):  
Toshimi Aizawa ◽  
Tetsuro Sato ◽  
Hiroshi Ozawa ◽  
Naoki Morozumi ◽  
Fujio Matsumoto ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Spinal Segment ◽  
Thoracic Myelopathy ◽  
Kyphotic Angle ◽  
Factors Affecting ◽  
Female Patients ◽  
Local Kyphosis ◽  
The Mean ◽  
Angle Method

Object The increased kyphosis after thoracic laminectomy in adult patients was retrospectively evaluated and various factors affecting this spinal deformity were analyzed. Methods The authors conducted a retrospective study of 58 cases in which laminectomy was performed and more than half of the facet joints were left intact. The study group included 44 men (mean age 59 years) and 14 women (mean age 61 years) with thoracic myelopathy due to ossifications of the ligamentum flavum and/or the posterior longitudinal ligament or due to posterior bone spurs. Patients were followed up for a minimum of 2 years. Their neurological condition was evaluated using the Japanese Orthopaedic Association (JOA) scale (a full score is 11), and the magnitude of local kyphosis in the laminectomized area was determined using the Cobb angle method. Results The mean preoperative JOA score was 5.4; the mean postoperative score was 8.3. No relationship was found between postoperative JOA score and increased kyphotic angle. The mean preoperative kyphotic angle was 7.0°. The mean postoperative kyphotic angle was 10.8°. Thus local kyphosis in the treated area increased by only 3.8°. The mean increase in kyphosis per spinal segment, calculated by dividing the kyphotic angle of the surgically decompressed area by the number of resected laminae, was 1.9°. Female patients with ≥ 3-level laminectomies showed a significant increase of kyphosis in both the laminectomized area and each spinal segment. Conclusions The increase in kyphosis after thoracic laminectomy is not large and thus spinal fusion is usually not necessary. In cases involving female patients who undergo long-segment laminectomies, however, careful radiographic follow-up is recommended.

Upper facet joint en bloc resection for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum

2013 ◽  
Vol 19 (1) ◽  
pp. 81-89 ◽  
Author(s):  
Zhong Yang ◽  
Yuan Xue ◽  
Qin Dai ◽  
Chao Zhang ◽  
H. Fang Zhou ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Ligamentum Flavum ◽  
Facet Joint ◽  
Neurological Status ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Pathological Examination ◽  
Thoracic Myelopathy ◽  
En Bloc ◽  
The Mean

Object The authors introduce a novel technique to treat thoracic myelopathy caused by ossification of the ligamentum flavum (OLF): upper facet joint en bloc resection. This surgical procedure avoids surgery to the most heavily compressed cord surface, contact with the cord, and cord injury. The epidural venous plexus bleeding point can be directly seen and easily controlled during the decompression. Methods Between January 2007 and January 2009, thoracic myelopathy caused by OLF was diagnosed in 38 patients using plain radiography, CT, and MRI, and diagnoses were confirmed by postoperative pathological examination. All upper facet joint en bloc resection procedures were performed in 2 steps. First, the bony structures above the upper facet joint surfaces were resected and the upper facet joints were isolated. Second, en bloc resection of the upper facet joint was performed by dissection of the junction between the pedicle and upper facet joint. Intraoperative neurological monitoring was performed in all cases. The modified Japanese Orthopaedic Association (mJOA) scoring system was used to assess neurological status. The degree of postoperative expansion of the spinal cord was calculated on axial MR images. The pre- and postdecompression Cobb angle was applied to assess the magnitude of local kyphosis. Results Of the 38 cases of OLF, 6 were single level, 12 were double level, and 20 were multilevel. Of the 92 ossified segments in this study, 23 (25.0%) were located in the upper thoracic spine (T1–4), 13 (14.1%) were located in the midthoracic spine (T5–8), and 56 (60.9%) were located in the lower thoracic spine (T9–L1). The mean intraoperative blood loss was 340 ± 54 ml. The neurological status improved during follow-up (mean 46.1 months) from a preoperative mean mJOA score of 5.39 ± 1.52 to 8.97 ± 1.22 points (t = 18.39, p < 0.05). The neurological function recovery rate ranged from 28.6% to 100%. The mean increase in pre- and postoperative kyphosis of the involved vertebrae was only 1.3° ± 1.6°. The increase in the cross-sectional area of the dural sac at the level of maximum compression suggested that decompression was complete. Conclusions Upper facet joint en bloc resection is effective and may be a reasonable alternative treatment choice for thoracic myelopathy caused by OLF.

Slipping rib syndrome: A clinical and dynamic-sonographic entity: A serial cases report

2021 ◽  
pp. 1-7
Author(s):  
Alba Girbau ◽  
Guillermo Álvarez-Rey ◽  
Carlos Leonardo Herrera-Cano ◽  
Ramón Balius
Keyword(s):  
Clinical Features ◽  
Traumatic Event ◽  
Correct Diagnosis ◽  
Case Series ◽  
Repetitive Movements ◽  
Dynamic Ultrasound ◽  
The Mean ◽  
Pain Mechanism ◽  
Event Dynamic ◽  
To Come

BACKGROUND: Slipping rib syndrome (SRS) consists of false or floating rib hypermobility, which can force the ribs to come into contact with each other. OBJECTIVE: We aimed to examine each case by dynamic ultrasound to determine their ultrasound characteristics and analyze the clinical features of patients with SRS in order to better manage and follow them up. METHODS: Retrospectively, we collected 14 case series presenting to SRS between June 2016 and September 2018. The diagnosis was clinical and confirmed by dynamic ultrasound maneuvers. RESULTS: The mean age was 35.00 ± 10.66 years and 64.29% was male. The pain mechanism was caused by repetitive movements or a traumatic event. Dynamic ultrasound was considered a very useful tool for the diagnosis. Different conservative treatments were applied in most cases. Eco-guided infiltration was also an option. CONCLUSIONS: SRS should initially be based on a clinic suspicion in order to achieve a correct diagnosis and management. It is an underdiagnosed syndrome, so these case series contribute to our knowledge regarding this syndrome.

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