Thoracic myelopathy caused by calcification of the ligamentum flavum / Journal of Rural Medicine

Calcification of the ligamentum flavum (CLF), which is a rare disorder that can potentially cause myelopathy, occurs uncommonly in the thoracic spine. Here, we report a rare case of thoracic myelopathy caused by CLF in a 78-year-old man. Magnetic resonance imaging (MRI) showed posterior spinal cord compression by a hypo-signal intense mass, and computed tomography (CT) revealed CLF and vacuum disc phenomenon at T10/11. After undergoing posterior decompression and instrumented fusion (T9–T12), the patient’s gait difficulties improved. The pathogenesis of CLF is largely unknown; however, it involves accumulation of calcium pyrophosphate dehydrate crystals (CPPD), and CLF from CPPD deposition tends to occur within a thickened and hypertrophic ligament. CLF occurs predominantly in the cervical spine and less frequently in the lumbar spine, with few cases involving the thoraco-lumbar spine. The thoracic spine is characterized by hypomobility; however, the thoraco-lumbar spine has a mobile segment which may potentiate CLF formation. Decompression with fusion surgery can be useful for treating patients with thoraco-lumbar CLF.

Degenerative Lumbar Spondylolisthesis with Spinal Stenosis: A Comparative Study of 5-Year Outcomes Following Decompression with Fusion and Microendoscopic Decompression

STUDY DESIGN: Retrospective review of prospectively collected outcome data. PURPOSE: To compare 5-year outcomes following decompression with fusion (FU) and microendoscopic decompression (MED) in patients with degenerative lumbar spondylolisthesis (DLS) and to define surgical indication limitations regarding the use of MED for this condition. OVERVIEW OF LITERATURE: There have been no comparative studies on mid- or long-term outcomes following FU and MED for patients with DLS. METHODS: Forty-one consecutive patients with DLS were surgically treated. Sixteen patients first underwent FU (FU group), and 25 then underwent MED (MED group). The 5-year clinical outcomes following the two surgical methods were compared using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. RESULTS: The degree of improvement (DOI) for social life function was significantly greater in the MED group than in the FU group. Although not statistically significant, DOIs for the other four functional scores were also greater in the MED group than in the FU group. However, patients with a large percentage of slippage in the neutral position might experience limited improvement in low back pain, those with a large percentage of slippage at maximal extension might experience limited improvement in three functional scores, and those with a small intervertebral angle at maximal flexion might have limited improvement in three functional scores after MED for DLS. Therefore, we statistically compared the DOIs between the FU and MED groups regarding the preoperative percentage of slippage in the neutral position among patients with greater than 20% slippage, the preoperative percentage of slippage at maximal extension among patients with greater than 15% slippage, and the intervertebral angle at flexion among patients with angles lesser than −5°; however, there were no statistically significant differences between the two groups. CONCLUSIONS: MED is a useful minimally invasive surgical procedure that possibly offers better clinical outcomes than FU for DLS.

A Comparison of Clinical Outcomes between Decompressive Laminectomy Alone and with Arthrodesis in Lumbar Single Level Spinal Stenosis

OBJECTIVE: By comparing the data of patients with spinal stenosis who had undergone decompressive laminectomy alone or with arthrodesis, we retrospectively analysed the advantages and disadvantages of the subsequent surgical techniques. METHODS: We analyzed the radiological parameters, surgical techniques, and clinical outcomes of 35 patients, who had undergone operation for spinal stenosis. The patients were divided into two groups, laminectomy alone(15 patients) and laminectomy with arthrodesis(17 patients) and the patients' subjective outcomes and radiological results were compared. RESULTS: Subjective satisfaction was higher in patients who had received decompressive degrees laminectomy alone(80%) than patients who received degrees decompressive laminectomy with arthrodesis(70%). The mean preoperative spinal lordotic angle in the laminectomy alone groups improved from 32.3 degree to 33.9 degree, postoperatively, and 33.1 degree at the last follow up. The mean preoperative spinal lordotic angle in the laminectomy with arthrodesis groups improved from 33.5 degree to 37.8 degree postoperatively, and 37.4 degree at last follow up. The lamine- ctomy with arthordesis group showed better results regarding spinal lordotic angle correction but this was not directly related to the clinical outcomes CONCLUSION: There was no significant correlation in clinical outcome, correction of spinal lordosis angle and patients' subjective satisfaction between decompressive laminectomy alone and with arthrodesis. Therefore, we suggested that decompressive laminectomy alone was achived good outcomes in patients who has single level spinal stenosis with no proven spinal instability at preoperative stage.

Surgical Treatment of Cervical Disc Herniation / 대한정형외과학회잡지

To evaluate the results of anterior decompression and fusion with autogenous bone graft for cervical disc disease, the authors reviewed 18 cases of cervical disc herniation which were treated surgically at Inje Univ. Paik Hosp. from 1990 to 1994 with special interest in the thickness of the bone graft. All cases have been followed for more than 12 months. We try to know the clinical results of anterior decompression and fusion with autogenous bone graft. At this treatment, controversial point is a ideal thickness of graft and the width of distraction. Therefore, we follow up the correlation between thickness of graft on roentgenogram and clinical results. The clinical results were satisfactory as excellent in 11 cases, good in 5 cases according to criteria of Robinson et al. Successful fusion occured in 16 cases within 3 months after their initial procedure, and fusion failure resulted in 2 cases. 3mm distraction from baseline disc height was considered ideal thickness of graft after anterior decompression and all cases healed successfully. We concluded that 3mm distraction from baseline disc height is necessary for successful decompression & fusion.