Espondiloartrosis cervical e hipertrofia del ligamento amarillo / Cervical Spondyloarthrosis and Hypertrophy of the Yellow Ligament

RESUMEN Introducción: La espondiloartrosis cervical es una enfermedad articular crónica degenerativa, es la afección articular más frecuentemente observada en la población madura y una de las principales causas de discapacidad en todo el mundo, por lo que es importante el diagnóstico y tratamiento en las fases tempranas. Objetivo: Informar un caso clínico representativo de espondiloartrosis cervical e hipertrofia del ligamento amarillo. Presentación del caso: Paciente femenina de 49 años que seis años atrás sufrió una caída, y se golpeó el occipucio contra la pared, lo que le provocó pérdida transitoria del conocimiento y dolor en la región cervical; tres años después comenzó con limitación a los movimientos laterales del cuello, malestar y dolor sordo, referido a la nuca y al cuello. Conclusiones: El diagnóstico de espondiloartrosis cervical e hipertrofia del ligamento amarillo representa un desafío clínico, por lo poco común de la enfermedad a esta edad. El caso presentado es una paciente con alteraciones estructuradas en el esqueleto axial y gran repercusión anatómica y funcional debido a un relativo diagnóstico tardío, con evolución insatisfactoria. Por tanto, conviene conocer la enfermedad para realizar una detección precoz y ofrecer mejor atención terapéutica(AU)

ABSTRACT Introduction: Cervical spondyloarthrosis is a chronic degenerative joint disease, it is the most frequent joint condition in the mature population and one of the main causes of disability throughout the world, so diagnosis and treatment in the early stages are important. Objective: To report a representative clinical case of cervical spondyloarthrosis and hypertrophy of the yellow ligament. Case presentation: A 49-year-old female patient suffered a fall six years ago, hitting her occiput against the wall, causing her temporary loss of consciousness and pain in the cervical region. Three years later, she began with limitation of lateral neck movements, discomfort and dull pain, referred to the nape and neck. Conclusion: The diagnosis of cervical spondyloarthrosis and hypertrophy of the yellow ligament represents a clinical challenge, due to the rare nature of the disease at this age. The case reported is a patient with structured alterations in the axial skeleton and great anatomical and functional repercussions due to a relatively late diagnosis, with unsatisfactory evolution. Therefore, it is convenient to know the disease in order to early detect it and to offer better therapeutic care(AU)

Pycnodysostosis with Multi-Segmental Spinal Canal Stenosis due to Ossification of the Yellow Ligament

Pycnodysostosis is an autosomal recessive disorder characterized by osteosclerosis, small stature, acro-osteolysis of the distal phalanges, loss of the mandibular angle, separated cranial sutures with open fontanels, and frequent fractures. One identified cause of the disease is reduced activity of the cysteine protease cathepsin K. A 48-year-old woman with a history of frequent fractures presented with a severe gait disturbance. Radiography, computed tomography, magnetic resonance imaging, and gene analysis were performed. Physical examination revealed open fontanels, and radiographs showed increased bone density. DNA sequence analysis revealed a deletion mutation of the cathepsin K gene. We diagnosed pycnodysostosis based on these findings. The magnetic resonance and computed tomography images demonstrated multilevel spinal canal stenosis due to ossification of the yellow ligament. We performed a laminectomy, and the patient's neurological signs and symptoms improved. To our knowledge, this is the first case of pycnodysostosis with ossification of the yellow ligament.

Prevalence, Distribution, and Significance of Incidental Thoracic Ossification of the Ligamentum Flavum in Korean Patients with Back or Leg Pain : MR-Based Cross Sectional Study

OBJECTIVE: Thoracic ossification of the ligamentum flavum (OLF) is a relatively rare disease. Because of ambiguous clinical symptom, it is difficult for early diagnosis of OLF and subsequent treatment can be delayed or missed. Therefore, the purpose of this study is to comprehensively assess the prevalence and distribution of thoracic OLF by magnetic resonance imaging (MRI) and coexisting spinal disease in Korean patients with back pain or leg pain. METHODS: The sample included 2134 Korean patients who underwent MRI evaluation for back pain. The prevalence and distribution of thoracic OLF were assessed using lumbar MRI with whole spine sagittal images. Additionally, we examined the presence of coexisting lumbar and cervical diseases. The presence of thoracic OLF as well as clinical parameters such as age, sex, and surgery were retrospectively reviewed. RESULTS: The prevalence of thoracic OLF in total patients was 16.9% (360/2134). The prevalence tended to increase with aging and was higher in women than in men. The lower thoracic segment of T10-11 was the most frequently affected segment. Of the 360 patients with OLF, 31.9% had coexisting herniated thoracic discs at the same level. Approximately 74% of the patients with OLF had coexisting lumbar and cervical disease. Nine (2.5%) of 360 OLF patients underwent surgery for thoracic lesion. CONCLUSION: The prevalenceof thoracic OLF was relatively higher than those of previous reports. And coexisting lumbar and cervical disease were very frequent. Therefore, we should check coexisting spinal diseases and the exact diagnostic localization of ossification besides lumbar disease.

Clinical Results And Prognostic Factors for Thoracic Myelopathy Caused by Ossification of Yellow Ligament after Surgical Treatment

STUDY DESIGN: Retrospective study. OBJECTIVES: We analyzed the clinical results of thoracic myelopathy caused by ossification of yellow ligament (OYL) and to explore prognostic factors after surgical treatment. SUMMARY OF LITERATURE REVIEW: Thoracic myelopathy due to OYL is difficult to treat; surgery is considered as treatment of choice. However, studies of the clinical results and prognostic factors are few due to its rare presentation. MATERIALS AND METHODS: Twenty six patients who had surgery for thoracic myelopathy caused by OYL were evaluated from February 2002 to April 2012. We describe the analysis of the clinical results after surgery and prognostic factors. RESULTS: Modified Japanese orthopedic association (JOA) score was recorded in all patients by 5.7+/-1.3 points (range, 2-9 points) preoperatively, 7.8+/-1.7 points (range, 4-10 points) postoperatively, and 8.4+/-2.1 points (range, 5-11 points) at final follow-up. Hirabayashi recovery rate was recorded by 60.2+/-20.2% (range, 45.5-72.0%) postoperatively, 64.5+/-17.3% (range, 50.2-75.1%) at final follow-up. The Visual Analogue Scale (VAS) score was also improved by 7.6+/-1.8 points (range, 7-10 points) preoperatively, 4.5+/-1.3 points (range, 3-6 points) postoperatively, and 3.8+/-1.6 points (range, 2-5 points) at final follow-up. Both modified JOA score and VAS score improved significantly (p<0.05). In prognostic factor analysis, OYL type on CT axial image, duration of symptom, and preoperative severity of myelopathy was significant (p<0.05). CONCLUSION: We showed the effectiveness of surgery on patients who suffer from thoracic myelopathy caused by OYL and that OYL type identified by CT axial image, duration of symptom, and preoperative severity of myelopathy were significant prognostic factors.

Symptomatic Myelopathy Caused by Ossification of the Yellow Ligament

OBJECTIVE: This study was performed to describe the clinical presentation, surgical outcome in patients with symptomatic myelopathy caused by ossification of the yellow ligament (OYL). METHODS: The authors reviewed consequent 12 patients in whom posterior decompressive laminectomies were performed for OYL from 1999 to 2005. Diagnostic imagings including simple radiographs, computed tomography and magnetic resonance images were performed in each case. The patients were reviewed to evaluate the clinical presentation, surgical outcome and complications of the operation. RESULTS: In all patients, OYL was located in the lower thoracic region and all patients presented with numbness on both limbs and pain. Among them, 5 patients presented with gait disturbance due to paraparesis and two patients had sphincter dysfunction. Decompressive laminectomy through a posterior approach using microscope resulted in improvement of symptoms in all patients, but, recovery was incomplete in a half of the patients. The mean postoperative Japanese orthopaedics association (JOA) score was 7.9 when compared with 4.9 in preoperative assessment and the mean recovery rate was 65%. Dural tear was noticed in four patients, so dural repair was performed, but there were no neurological deficits related to neural injury. CONCLUSION: OYL is an uncommon cause of myelopathy but it can lead to debilitating thoracic myelopathy. Careful decompressive laminectomy can achieve favorable results.

Experimental study on viscoelasticity of lumbar yellow ligament in young and old people / 医用生物力学

Objective To compare the stress relaxation and mechanical properties of creep viscoelasticity in the young and old’s spine and to provide the reference for the mechanical mechanism of viscoelasticity of yellow ligament degeneration. Method Twenty specimens of elderly patients with degenerative lumbar yellow ligament degeneration as the older group, and twenty specimens of young patients with lumbar yellow ligament injuries as the youth group were used respectively. All the yellow ligament specimens were from the yellow ligament between the fourth and fifth of lumbar vertebra (L4~L5). Stress relaxation experiment and creep experiment were conducted on the specimens by the strain increasing speed as 1%/s and the stress increasing speed as 0.5 MPa/s respectively. The experimental temperature was (36.5±0.5) ℃ and the experimental time was 7 200 s. Ninety stress relaxation and creep data were collected, and the data were dealt with the statistical analysis and normalization methods. Results The 7 200 s stress of yellow ligament in the youth group decreased by 1.42 MPa, while the 7 200 s stress of yellow ligament in the older group decreased by 1.91 MPa. The 7 200 s strain of yellow ligament in the youth group increased by 3.39%, while the 7 200 s strain of yellow ligament in the older group increased by 2.07%. The 7 200 s stress in two groups all increased and the increased strain data showed statistically significance (P<0.05). The stress relaxation curve changed in the form of logarithm and the creep curve changed in the form of index. Conclusions The 7 200 s stress relaxation and creep in the yellow ligament of the older group all decreased and the mechanical properties of viscoelasticity changed.

Conservative Treatment of Thoracic Radiculopathy due to Ossification of the Yellow Ligament in a Young Patient: A case report

Ossification of the yellow ligament (OYL) is a pathologic condition that causes spinal stenosis, which is a form of ectopic ossification. OYL causes compressive myelopathy and radiculopathy. Although the pathogenesis of OYL is still unclear, diffuse mechanical stresses and degenerative changes caused by extreme ranges of motion may be related to the development of OYL in young sportsmen. Here we report an interesting case of thoracic radiculopathy due to OYL in a 35-year-old male amateur judo player who was successfully treated with continuous thoracic patient controlled epidural analgesia and epidural adhesiolysis.

Fracture of Ossification of the Yellow Ligament Causing Thoracic Myelopathy: A Case Report / 대한척추외과학회지

Ossification of the yellow ligament (OYL) is a rare disease that causes myeloradiculopathy at the thoracic spine. The advances in radiographic imaging techniques have made a diagnosis of this pathological entity relatively simple. Surgical decompression and excision of the OYL is the treatment of choice if there are neurological complications from the OYL. We describe a 50-yearold male with thoracic myelopathy caused by a fractured OYL at T10-11, and suggest possible mechanism of the fracture of the OYL at the thoracolumbar spine.

Cervical Myelopathy due to Ossification of Yellow Ligament in a Patient with Reiter's Syndrome / 대한척추외과학회지

Reiter's syndrome is described as an inflammation of the joints and tendon attachments at the joints, and is often accompanied by an inflammation of the eye;s conjunctiva and the mucous membranes, such as those of the mouth, urinary tract, vagina, and penis, and by a distinctive rash. Ossification of the yellow ligament associated with Reiter's syndrome has never been reported A 41-year old male patient with Reiter's syndrome was admitted to our hospital due to cervical myelopathy caused by ossification of yellow ligament. He was treated with laminectomy and fusion, from C3 to C7, by using a lateral mass screw and plate fixation. Laminectomy and fusion seems to be an appropriate treatment option for cervical myelopathy due to ossification of yellow ligament.

Clinical Study on Lumbar Stenosis Using Computed Tomography

Since developmental lumber atenosis was described by Verbiest in 1954, there have been many reports on lumbar stenosis. But there have been many limitations in diagnosis and treatment of lumbar stenosis. Recently, the development of water-soluble contrast media and high resolution spine CT scan have not only brought about significant progress in diagnosis of the etiology and levels of lumbar stenosis, but also better surgical therapetic results could be expected. The author has reviewed 433 patients with lumber stenosis operated at the department of Neurosurgery YUMC Yongdong Severance hospital from March 1983 to September 1987 and analyzed the measurements of various parts of the spinal canal by high resolution spine CT scan, and evaluated the clinical courses and their surgical outcomes. The results were summarized as following: 1) Male to female ratio was 1:1.3. The peak age incidence were 40's in male and 50's in female. 2) By the causes of lumbar stenosis, degenerative stenosis was most common as 78%, and followed by degenerative spondylolisthesis 7.2%, spondylolytic spondylolisthesis(1.6%), iatrogenic stenosis(1.6%), developmental stenosis(0.7%) and posttraumatic stenosis(0.7%). 3) Single level stenosis was most common(47.1%), two levels 32.8% and three levels or more 20.1%. In the single level stenosis L4/5 was most common as 85.8% and L5/S1 10.3%. In the two levels stenosis, L4/5 and L4/S1 were most common at 72.5% and L3/4 and L4/5 26.1%. 4) The characteristic clinical symptoms were chronic back pain and neurogenic intermittent claudication(65.6%). Few patient showed abnormal neurological findings. Common abnormal sign was loss or decrease of ankle jerk(73%). The straight leg raising test was not significant, and it was positive only in 10.3%. 5) In diagnosis of lumbar stenosis, it was most important to identify the causes of lumbar stenosis and degree of compression on cauda equina, or lateral recess stenosis by the spine CT or spine CT myelograms. 6) On myelogram, the findings of complete or incomplete block were present in 44.1%, and indentations of contrast dye column at the levels of stenosis was noted in 55.9%. 7) The common findings on spine CT scan were hypertrophy of posterior articular facet joints(65.8%), osteophyte formation(37.1%), thicking of yellow ligament(21.7%), ossification of posterior longitudinal ligament(23.8%), ossification of yellow ligament(4.9%). 8) In the diagnosis of degenerative lumbar stenosis with high resolution of spine CT scan, anteroposterior diameter of spinal canal was not so significant, but the cross sectional areas of dural sac and spinal canal were most sensitive indexes. The anteroposterior diameter of dural sac and interfacetal distance provided th e clue of lumbar stenosis. If the anteroposterior diameter of the lateral recess was less than 3mm it could be diagnosed as the lateral recess stenosis. And if the angle between both yellow ligaments(yellow ligament angle, Y-angle) was less than 60( it must be suspected as the central stenosis. 9) In the examination of degenerative spondylolisthesis with spinal CT scan, anterior-posterior diameter and cross sectional area of spinal canal and dural sac at the disc level were smaller than those of upper and lower vertebral levels. The angle of yellow ligament was almost normal. 10) For the definite treatment wide decompressive laminectomy, medial facetectomy and foraminotomy should be carried out. 11) Our results of surgery were good to excellent in 90.3% and fair to poor 9.7%.