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.

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.

Upper Thoracic Myelopathy Caused by Delayed Neck Extensor Weakness in Myotonic Dystrophy

Myotonic dystrophy is the most common autosomal dominant myopathy in adults. Our patient, a 41 year-old female suffering from myotonic muscular dystrophy, developed upper thoracic myelopathy due to hypertrophy of the ligamentum flavum and the posterior longitudinal ligament. She had a typical hatchet face and ptosis with "head hanging forward" appearance caused by neck weakness. Motor weakness, sensory changes and severe pain below T4 level, along with urinary incontinence began 3 months ago. Genetic and electrodiagnostic studies revealed myotonic dystrophy type 1. Magnetic resonance imaging of the spine showed loss of cervical lordosis and spinal cord compression due to hypertrophied ligamentum flavum and posterior longitudinal ligament at T1 to T3 level. We concluded that her upper thoracic myelopathy was likely related to the thickness of the ligamentum flavum and posterior longitudinal ligament due to repetitive mechanical stress on her neck caused by neck muscle weakness with myotonic dystrophy.

Intravascular Lymphomatosis of the Central Nervous System Presenting Progressive Paraparesis

No abstract available.

Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

OBJECTIVE: Ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy. The aim of this study was to identify factors associated with the surgical outcome on the basis of preoperative clinical and radiological findings. METHODS: Data obtained in 26 patients whot underwent posterior decompression for thoracic myelopathy, caused by thoracic OLF, were analyzed retrospectively. Patient age, duration of symptoms, OLF type, preoperative and postoperative neurological status using the Japanese Orthopedic Association (JOA) scoring system, surgical outcome, and other factors were reviewed. We compared the various factors and postoperative prognosis. All patients had undergone decompressive laminectomy and excision of the OLF. RESULTS: Using the JOA score, the functional improvement was excellent in 8 patients, good in 14, fair in 2, and unchanged in 2. A mean preoperative JOA score of 6.65 improved to 8.17 after an average of 27.3 months. According to our analysis, age, gender, duration of symptoms, the involved spinal level, coexisting spinal disorders, associated trauma, intramedullary signal change, and dural adhesions were not related to the surgical outcome. However, the preoperative JOA score and type of OLF were the most important predictors of the surgical outcome. CONCLUSION: Early diagnosis and sufficient surgical decompression could improve the functional prognosis for thoracic OLF. The postoperative results were found to be significantly associated with the preoperative severity of myelopathy and type of OLF.

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.

Thoracic Myelopathy in Elderly Patients with Degenerative Lumbar Scoliosis / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical findings and effective management of thoracic myelopathy combined with degenerative lumbar scoliosis. MATERIAL AND METHODS: Seven cases with degenerative lumbar scoliosis of more than 10 degrees and underwent surgery on the thoracic spine were retrospectively studied through a chart review and the radiological findings. The mean follow-up period was 32.3 months. The average age was 65.3 years (range, 61-82 years), and there were 4 males and 3 females. 5 cases underwent a lumbar laminectomy with or without fusion prior to admission. The patients were evaluated through their history, physical examination, period of symptoms, MRI findings and surgical methods. A clinical evaluation was carried out using the Oswestry Disability Index (ODI). RESULTS: All cases had decreased hip flexion and a spastic gait, along with various degrees of radiating pain and buttock pain. No case had pathological reflexes but various degrees of motor and sensory disturbances were observed. The preoperative MRI findings showed herniated discs at the level of T5-6 (1 case), T6-7 (1 case), T8-9 (2 cases), T9-10 (1 case), T9-12 (1 case) and T10-12 (1 case). Decompression through the anterior approach was carried out on 4 cases, and decompression and posterior fusion was carried out on 3 cases. The average preoperative ODI was 28.6 points (range, 25-34) and improved to 12.3 points (range, 10-15), respectively at the final follow-up. CONCLUSION: Although thoracic myelopathy combined with degenerative lumbar scoliosis is a rare disease, pathognomonic symptoms such as gait disturbances highlight the need for considering the appropriate management and surgical level through a differential diagnosis with simple degenerative lumbar scoliosis.

A Diffuse Idiopathic Skeletal Hyperostosis Patient Associated with Ossification of Thoracic Ligamentum Flavum: A Case Report / 대한정형외과학회잡지

Diffuse idiopathic skeletal hyperostosis (DISH), which is also known as Forestier's disease, is an idiopathic rheumatological abnormality in which extensive ossification occurs along the ligaments throughout the body, most notably in the anterior longitudinal ligament of the spine, and frequently in the posterior longitudinal ligament or ligamentum flavum. Ossification of the ligamentum flavum (OLF) causes narrowing of the spinal canal and cord compression. Radiculopathy, myelopathy or combined neurological alterations can be elicited as a result of ossification. We performed a long-term follow-up of a case progressive myelopathy caused by nodular ossification of the ligamentum flavum in a patient with DISH, who was treated with a posterior decompressive laminectomy and the removal of the ossified ligamentum flavum.

Thoracic Myelopathy due to Thoracolumbar Kyphosis and Spinal Stenosis in Achondroplasia: A Case Report / 대한척추외과학회지

Achondroplasia is abnormal intracartilagenous ossification that's caused by a genetic point mutation. Thoracic myelopathy in achondroplasia that is due to thoracolumbar kyphosis and spinal stenosis is a rare finding. There is no report available on this topic in Korea. We report here a case of achondroplasia with thoracic myelopathy due to thoracolumbar kyphosis and spinal stenosis, and we include a brief review of literature.

Thoracic Myelopathy Due to Ossification of Ligamentum Flavum: Three cases Report / 대한척추외과학회지

Ossification of the ligamentum flavum (OLF) is a definite clinical entity and is thought to be a form of ectopic ossification which develops predominantly in the lower thoracic spine. OLF causes progressive compressive myelopathy, radiculopathy, or combination of both. We experienced 3 cases of OLF with neurological symptoms, which were treated by posterior decompressive laminectomy and removal of the ossified ligamentum flavum with or without fusion with symptomatic improvement.

Thoracic Myelopathy Caused by Multiple Ossified Ligamentum flavum Combined with Ossification of the Posterior Longitudinal Ligament

The authors report a case of thoracic myelopathy caused by multiple ossification of the ligamentum flavum(OLF) combined with ossification of the posterior longitudinal ligament(OPLL). A 52-year-old man had progressive motor weakness and numbness in the lower extremities. Diagnosis was made from the MR imaging that provided useful information about the multiple lesions in the lower cervical and upper thoracic area and about the degree of spinal cord compression. The surgical approach consisted of two stages: Posterior decompression for OLF(first stage) and anterior decompression for OPLL, followed by interbody fusion(second stage). The patient had satisfactory improvement after surgical intervention.

Thoracic Ossified Ligamentum Flavum: A Clinical Analysis of 16 Cases

The authors are reporting 16 cases of ossification of the thoracic ligamentum flavum. Thoracic ossified ligamentum flavum cause myelopathy as a result of pressure on the spinal cord and nerve roots. The prominent symptoms were numbness of the foot or leg, motor weakness, sphincter disturbance and exaggerated tendon reflexes. The male to female ratio was 13:8 and the 5th decade was the most prevalent age group. The predominant regions involved were T9-T10 and T10-T11. Total larminectormy was performed in all patients and the prognosis was good in most cases. The thoracic ossified ligamentum flavum and neurologic disorders due to compression of the thoracic vertebrae by other diseases do not show much of a difference in terms of symptoms. In the past, due to the lack of knowledge of this disease, treatment was performed inapproapriately. However, at the present, with the improvement of CT and MRI and the increased recognition of this disease we believe that good prognosis can be made if appropriate treatment is delivered at the time of diagnosis.

Thoracic Myelopathy Caused by Ossified Ligamentum Flavum: Case Report

A rare case of thoracic myelopathy caused by the ossification of hypertrophied ligamentum flavum is presented. A fourty-year old male complained of decreased pain, temperature, touch sense at right lower limb, weak urinary stream, poor penile erection, and constipation. CT revealed an ovoid, homogeneously high density at the site of left T10-11 ligamentum flavum, which compressed the spinal cord posterolaterally. MR imaging showed significant spinal cord compression on the left posterolateral aspect at T10-11 level by a well-defined purely low-intensity signal lesion. Simple spine X-rays did not show any abnormality. T10 total laminectomy and removal of the ossified ligamentum flavum resolved his neurological dysfunction. Clinical summary of the case is presented and the corresponding literature are reviewed.

Posterior Tibial Somatosensory Evoked Potentials (PTSEPs) in Thoracic Myelopathy

The authors perforrned the posterior tibial somatosensory evoked potentials(PTSEP) on 37 patients who had typical symptoms and signs of thoracic myelopathy to evaluat the value of the PTSEP in diagnosing and differentiating among the thoracic lesions The result showed the abnormal PTSEP features which were suggestive of thoraci myelopathy in 33 of 37(89.2%). The most frequent abnormalities were the prolonged central conduction(59.5%), which were either the only one(40.6%) or combined with poor wave formation (18.9%). The second comrnon abnorrnal PTSEP findings were the decreased P1 amplitude relative to TN1 amplitude with hanng nonnal value of TN1-P1 interwave latencies (29.7%). When we divided those 37 subjects into the demyelinating (N =19) and the non-demyelinating group(N=18), the prolonged TN1-P1 interwave latencies were more prominent in the demyelinating(68.4%) than in the non-demyelinating group (50.0%). In contrast, the only relative reduction of P1 amplitude with normal central conduction was more marked in the non-demyelinating(38.9%) than in the demyelinating group(21.1%). However, both of them did not show statistical significances (p<0.254, p<0.235, respectively). The PTSEP methods were found superior to spine MRI in sensitivity in the demyeli nating group, as the PTSEP revealed abnormal findings in 12 subjects with normaI spine MRI. Therefor it is concluded that the PTSEP studies would be helpful in diagnosing the thoracic lesions, especially in patients with the demyelinating lesions. However. Those pararnmters of the prolonged central conduction(TNl-P1) or the relative amplitude redu ction of cortical patentials(P1) were not significant in differentiating the demyelinating from the non-demyelinating lesions.

A Case of Thoracic Spinal Canal Stenosis

A compression of spinal cord or nerve roots is commonly seen sequale of acquired or congenital stenosis of the cervical of lumbar portions of the spine. The authors have treated a case of thoracic myelopathy associated with thoracic canal stenosis, which was diagnosed with thoracic myelography and thoracic C-T scan. The pathological findings was thickened ligament flavum, hypertrophied articular processes, narrow spinal canal and compression of spinal cord. It is suggested that the syndrome should be considered in any patient who has a thoracic myelopathy.

OSSIFICATION OF THE LIGAMENTUM FLAVUM IN THE THORACIC SPINE: A REPORT OF TWENTY-SIX CASES / 解放军医学杂志

Twenty-six patients with stenosis of the thoracic spinal canal and myelopathy caused by ossification of the ligamentum flavum were treated from 1983 to June 1991. There were 21 patients with spastic paraplegia and 5 with flaccid paraplegia in the series. The findings on radiograms, CT scans, myelograms and MRI were described. Total laminectomy was performed in all of the patients which resulted in an effective rate of 91.6% and exellent and good results in 83.3%. The mechanism of the disease our experience in diagnosis and surgical treatment, causes of misdiagnosis and surgical techniques are discussed.