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Cervical Laminoplasty for Multilevel Cervical Myelopathy  [PDF]
Murali Krishna Sayana,Hassan Jamil,Ashley Poynton
Advances in Orthopedics , 2011, DOI: 10.4061/2011/241729
Abstract: Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy.
Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy  [cached]
Singhal Udit,Jain Manoj,Jaiswal Awadhesh,Behari Sanjay
Indian Journal of Orthopaedics , 2009,
Abstract: High cervical ossified ligamentum flavum (OLF) is rare and may cause progressive quadriparesis and respiratory failure . Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring). The first patient had a linear and nodular OLF with calcification within tectorial membrane, C2-3 fusion and unilateral C2-facetal hypertrophy; and the second patient, a lateral, linear OLF with loss of lordosis and C3-6 spondylotic changes. A decompressive laminectomy using "posterior floating and enbloc resection" brought significant relief in myelopathy. Histopathology showed mature bony trabeculae, bone marrow and ligament tissue. The coexisting mobile cervical vertebral segment above and congenitally fused or spondylotic rigid segment below the level of LF may have led to abnormal strain patterns within resulting in its unilateral ossification. In dealing with cervical OLF, carefully preserving facets during laminectomy or laminoplasty helps in maintaining normal cervical spinal curvature.
Cervical Laminoplasty for Multilevel Cervical Myelopathy  [PDF]
Murali Krishna Sayana,Hassan Jamil,Ashley Poynton
Advances in Orthopedics , 2011, DOI: 10.4061/2011/241729
Abstract: Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy. 1. Introduction Chronic compression of the cervical spinal cord leads to a clinical syndrome of cervical spondylotic myelopathy (CSM). In degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the PLL (OPLL) can all cause spinal cord compression. The effect on spinal cord compression is much more pronounced if a patient has a congentially small spinal canal. The aetiopathogenesis, clinical manifestations, investigations, and nonoperative management are discussed in other articles of this special edition. The primary aims of surgical intervention for multilevel myelopathy are to decompress the spinal cord and maintain stability of the cervical spine. Secondary aims are to minimize complications which include long-term pain and motion loss. This can be achieved by anterior approach and/or posterior approach to cervical spine. Anterior approach would involve multilevel discectomy at times with corpectomy and fusion. Posterior approach would involve laminectomy with or without fusion or laminoplasty. This article will focus on cervical laminoplasty for multilevel myelopathy. 2. Evolution of Laminoplasty Kirita, in 1968, devised a sophisticated operative technique, in which the laminae were thinned and divided at the midline using a high-speed drill followed by their en bloc resection to achieve total decompression of the compressed spinal cord [1]. Although this technique improved the results and bettered the technique of conventional laminectomy, complications like postoperative kyphosis and membrane formation resulted. Oyama et al. reported a Z-plasty (Hattori technique) of the cervical spine laminae in 1973 [2]. This procedure was technically demanding and had not been adopted widely other surgeons. In the year 1977, Hirabayashi et al. described an expansive open door laminoplasty (ELAP), which is a relatively easier and safer procedure than laminectomy [3].
Calcification of the ligamentum flavum in the thoracolumbar spine: an unusual cause of compressive myelopathy Calcification of the ligamentum flavum in the thoracolumbar spine: an unusual cause of compressive myelopathy  [cached]
Jo?o Augusto dos Santos Martines,Brenda Margatho Ramos Martines,Cláudio Campi de Castro,José de Arimatéia Batista Araújo Filho
Autopsy and Case Reports , 2012,
Abstract: The focal calcification or ossification of the ligamentum flavum is a rare cause of thoracic myelopathy and most often occurs among individuals of Japanese descent. It is rare in other ethnic groups and in individuals below the age of 50. It is most often described at the lower thoracic level, being uncommon in the lumbar region and rare in the cervical region. Here, we present the case of a 44-year-old White female patient who sought medical attention with an eightmonth history of paraesthesia of the lower limbs and progressive difficulty in walking. The clinical profile, together with computed tomography and nuclear magnetic resonance imaging of the spine, led to a diagnosis of compressive thoracic myelopathy due to ossification of the ligamentum flavum in the thoracic and lumbar spine. The patient underwent laminectomy and dissection of some of the affected ligamentum flavum, without any intraoperative complications. After three months of clinical follow-up, the patient had progressed favorably, having no sensory complaints and again becoming ambulatory. nulo
Thoracic myelopathy due to ossified hypertrophied ligamentum flavum  [PDF]
Jaisuresh K,Kumar VP,Sundaravadivelu V
Calicut Medical Journal , 2007,
Abstract: Calcification of ligamentum flavum is a rare disease that wasfound to occur almost exclusively in Japanese population.However the disease is now being increasingly recognized as acause of thoracic myeloradiculopathy in Indian Population. Wereport a case of thoracic myelopathy at multiple levels due toOssified and hypertrophied ligamentum flavum.
Clinical Outcome after Laminectomy without Fusion for Cervical Spondylotic Myelopathy  [PDF]
Kerstin Woernle, Serge Marbacher, Abdussalam Khamis, Hans Landolt, Javier Fandino
Open Journal of Modern Neurosurgery (OJMN) , 2015, DOI: 10.4236/ojmn.2015.52007
Abstract: Dorsal decompression in patients, presenting with cervical spondylotic myelopathy with no signs of instability, is a standard surgical option. Laminectomy or laminoplasty is applied to reduce the pressure on the myelon. The aim of this study was to evaluate the clinical outcome in a consecutive series of patients. This retrospective study included a total of 65 patients who underwent laminectomy or laminoplasty at a single or more levels, without fusion for cervical spondylotic myelopathy, during an 8-year period (2000-2007). The clinical data evaluation included pre- and postoperative patient history and neurological and surgical variables. The radiological assessment included MRI, CT, and plain anterior-posterior, lateral, and lateral flexion-extension X-rays. The mean follow-up time was 15 months. Improvement of gait disturbance was documented in 74% of the patients concerned. Radicular pain in the upper limbs (UL) and lower limbs (LL) improved in 87% and 50% of the patients, respectively. Sensory deficits improved in the UL and LL in 76% and 54%, respectively. Motor deficits improved in the UL and LL in 70% and 56% of the patients, respectively. Clinical deterioration after surgery was documented in one patient. Based on our results, laminectomy without fusion can be advocated as a safe and effective surgical strategy to treat cervical spondylotic myelopathy in patients without preoperative instability. In these patients, the occurrence of post-procedural clinical deterioration and instability was low, and overall improvement of neurological deficits and amelioration of radicular pain can be expected in a significant number of patients.
Ligamentum flavum hematoma: a case report and literature review
Sfreddo, Ericson;Guerra, Marcelo Teodoro Ezequiel;
Coluna/Columna , 2012, DOI: 10.1590/S1808-18512012000100016
Abstract: the aim is to present a rare case of ligamentum flavum hematoma in the lumbar region, discuss its physiopathology and treatment and review the literature. a woman aged 68 presented with neurogenic claudication due to degenerative lumbar spondylolisthesis that evolved into a sudden worsening with cauda equina syndrome. the magnetic resonance imagining (mri) showed signs of degeneration of the lumbar spine, with a narrow spinal canal from l2 to s1, anterolisthesis l4 l5 and an expansive lesion hyperintense on t1-weighted and hypointense on t2-weighted images considered compatible with hematoma in the topography of the yellow ligament in l1-l2. the patient underwent laminectomy and lumbar fixation. her evolution was good in the postoperative period and at 18 months of follow-up hse walked alone, despite the pain that is controlled with simple medications. even though rare, it seems that ligamentum flavum hematoma has a relationship with the degeneration and rupture of small vessels associated with micro trauma to the spine. its physiopathology is not well defined and treatment is similar to other spine compression processes.
Rare ligamentum flavum cyst causing incapacitating lumbar spinal stenosis: Experience with 3 Chinese patients
Alexander Chan, Tsz Wong, Koon-Man Sieh, Simon Leung, Kai-Yin Cheung, Kwai-Yau Fung
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-81
Abstract: Lumbar spinal stenosis is commonly caused by degenerative conditions, such as herniated nucleus propulsus, or hypertrophy of facet joint or ligamentum hypertrophy. Less common aetiologies include intraspinal extradural masses, including synovial cysts [1], ganglion cysts [2], pseudocysts, haematoma, metastatic tumour. Cyst originated from ligamentum flavum is even more uncommon. Few reported cases of spinal stenosis and radiculopathy were caused by ligamentum flavum cysts and none of these are from the Chinese population [3-8]. We describe our experiences of Chinese patients suffering from spinal stenosis due to ligamentum flavum cysts.A 74-year-old man presented with 1-year history of progressive bilateral leg weakness with left side being more affected. He walked with frame in the most recent 3 months. There was no history of trauma or other constitutional symptoms.Clinical examination revealed moderate weakness (grade 3/5) of the left ankle dorsiflexion, flexion and extension of the left great toe. Otherwise, motor examination of the other muscle groups was normal. Sensation of both lower limbs was intact. The left knee reflex was diminished whereas both side ankle reflexes were absent.Plain radiographs of the lumbosacral spine showed degenerative changes. Blood parameters showed normal white cell count (WCC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Magnetic Resonance Imaging (MRI) scan showed a cystic lesion, T1 hypointense and T2 hyperintense with moderate rim enhancement in between dural sac and ligamentum flavum at L3/4 level, compressing and displacing cauda equina (Figure 1A, B).The patient was treated conservatively with a short course of analgesics and physiotherapy. This regimen failed to alleviate the patient's symptoms. Posterior decompression by L3 laminectomy was performed. Intraoperatively, a cyst was noted in the epidural space spanning the whole of ligamentum flavum in a transverse and cranio-caudal direction at L3/4 lev
Thoracic myelopathy caused by ossification of ligamentum flavum of which fluorosis as an etiology factor
Wenbao Wang, Linghua Kong, Heyuan Zhao, Ronghua Dong, Jing Zhou, Yun Lu
Journal of Orthopaedic Surgery and Research , 2006, DOI: 10.1186/1749-799x-1-10
Abstract: All the patients with thoracic OLF, who underwent surgical management in the authors' hospital from 1993–2003, were retrospectively studied. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis existed. The neurological statuses were evaluated with the Japanese Orthopaedic Association (JOA) scoring system preoperatively and at the end point of follow up. Also, the recovery rate was calculated.23 cases have been enrolled in this study. Imaging study findings showed all the cases have ossification of ligamentum flavum together with ossification of many other ligaments and interosseous membranes, i.e. interosseous membranes of the forearm in 18 of 23 (78.3%), of the leg in 14 of 23 (60.1%) and of the ribs in 11 of 23 (47.8%). Urinalysis showed markedly increased urinary fluoride in 14 of 23 patients (60.9%). All the patients were followed up from 12 months to 9 years and 3 months, with an average of 4 years and 5 months. The JOA score increased significantly at the end of follow up (P = 0.0001). The recovery rate was 51.83 ± 32.36%. Multiple regression analysis revealed that the preoperative JOA score was an important predictor of surgical outcome (p = 0.0022, r = 0.60628). ANOVA analysis showed that patients with acute onset or too long duration had worse surgical result (P = 0.0003).Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. En bloc laminectomy decompression was an effective method. Preoperative JOA score was the most important predictor of surgical outcome. Patients with acute onset or too long duration had worse surgical outcome.Fluoride is an important element for bone mineralization. It causes an increase in bone mass by stimulation of the osteoge
Ossification Of The Ligamentum Flavum: Rare Cause Of The Thoracic Myelopathy  [PDF]
Emel AVCI,Adil OZTURK,Fusun BABA,Seyho YUCETAS
Journal of Neurological Sciences , 2008,
Abstract: Ossification of ligamentum flavum is a rare cause of thoracic myelopathy. Most of the reported cases are from Japan and it is rarely seen in other races. Here, we present a 40 years old female patient presented with progressive paraparesis and urinary incontinence secondary to ossification of ligamentum flavum at the level of the T8-9.
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