A 39-year-old man presented with recurrent lower back and leg pain for 8 months due to repeated hemorrhage into an L5 ligamentum flavum cyst. Lumbar MR imaging showed an extradural cystic mass originating from the ligamentum flavum on the right side in the L5 segment. Microsurgical laminotomy and flavectomy were performed. The symptoms resolved completely and the patient had an uneventful postoperative recovery.
Adult ; Cysts ; diagnosis ; surgery ; Humans ; Ligamentum Flavum ; pathology ; surgery ; Male

BACKGROUNDSurgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion (PTTIF) may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.

METHODSSixteen patients with thoracic myelopathy due to concurrent OLF and OPLL at the same level underwent PTTIF. We investigated clinical outcomes and neurological improvements. Magnetic resonance imaging (MRI) was performed on all patients preoperatively and postoperatively, and intramedullary signal changes were evaluated.

RESULTSThe mean operating time was 275 minutes, and the mean operative bleeding amount was 1031 ml. Cerebrospinal fluid leakage occurred in three patients and healed well after repair. Neurological symptom deterioration occurred in one patient, but the patient recovered to nearly the preoperative level after methylprednisolone treatment. The follow-up period ranged from 28 to 47 months. The mean score on the Japanese Orthopedic Association scale improved from 4.3±1.2 preoperatively to 7.3±1.7 at 3 months postoperatively to 8.5±1.5 at the final follow-up (P < 0.01), with a recovery rate of (63.6±20.0)%. Postoperative images showed a significant improvement in local kyphosis (P < 0.01). Eleven patients (68.8%) showed increased signal intensity (ISI) on preoperative T2-weighted MRI. At the final follow-up, the intramedullary ISI totally recovered in five patients. Neurological improvement was worse in patients with persistent ISI than in the other patients (P < 0.05).

CONCLUSIONSPTTIF is an effective therapeutic option for combined OPLL and OLF and provides satisfactory neurological recovery and stabilized thoracic fusion through a single posterior approach. Intramedullary signal changes do not always indicate a poor prognosis; only irreversible ISI is correlated with a poor clinical result.

Adult ; Aged ; Decompression, Surgical ; Female ; Humans ; Ligamentum Flavum ; pathology ; surgery ; Longitudinal Ligaments ; pathology ; surgery ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; pathology ; surgery ; Spinal Cord Diseases ; pathology ; surgery

Acute neurologic deterioration is not a rare event in the surgical decompression for thoracic spinal stenosis. We report a case of transient paraparesis after decompressive laminectomy in a 50-yr-old male patient with multi-level thoracic ossification of the ligamentum flavum and cervical ossification of the posterior longitudinal ligament. Decompressive laminectomy from T9 to T11 was performed without gross neurological improvement. Two weeks after the first operation, laminoplasty from C4 to C6 and additional decompressive laminectomies of T3, T4, T6, and T8 were performed. Paraparesis developed 3 hr after the second operation, which recovered spontaneously 5 hr thereafter. CT and MRI were immediately performed, but there were no corresponding lesions. Vascular compromise of the borderlines of the arterial supply by microthrombi might be responsible for the paraparesis.
*Cervical Vertebrae/pathology/surgery ; Decompression, Surgical/adverse effects ; Humans ; Laminectomy/*adverse effects ; *Ligamentum Flavum/pathology/surgery ; *Longitudinal Ligaments/pathology/surgery ; Male ; Middle Aged ; *Ossification, Heterotopic ; Paraparesis/*etiology

OBJECTIVETo explore operative method and clinical effect of selective fenestration of cervical vertebral lamina to excise ligamentum flavum for treating hypertrophic ligamentum flavum (HLF).

METHODSFrom March 1998 to May 2007, 21 patients (14 males and 7 females) with HLF were reviewed retrospectirely, whose age was from 37 to 76 years with an average of 52.2 years. The history of HLF was from 5 h to 25 years with an average of 3 years and 10 months. Reason of onset: 4 cases were no inducement, 10 cases were slow-moving,and 7 cases caused by injury. The operative effect was assessed according to JOA scores and radiologic results.

RESULTSAll patients were followed up with an average of 2.5 years(ranging from 3 months to 7.5 years). Radiologic results: sagittal diameter of vertebral canal and trans.sec.area increased and spinal cord were well than preoperative status. The majority of cases got stronger in the walking, improvement in the fingers mobility and holding power and using chopsticks, abatement in the limbs numb and thoracic waist zonesthesia, amelioration in the urination and defecation functional disturbance than preoperative symptom. The JOA scoring was 5-16 scores with an average of 11.48 +/- 2.94 before operation,and 7-17 scores with an average of 13.81 +/- 2.98 after operation. That results had statistical significance between before and after operation (t = 3.51, P < 0.05). There were 13 cases excellent (improvement rate more than 75%), 5 cases good (improvement rate in 50%-74%), 2 cases fair (improvement rate in 25%-49%), 1 case poor (improvement rate less than or equal to 24%) with an average improvement rate of 85.2%.

CONCLUSIONIt is simple in the operative procedure and tiny in trauma in treatment for hypertrophic ligamentum flavum with selective fenestration of cervical vertebral lamina to excise ligamentum flavum. The method can obtain effective decompression for vertebral canal but choice of indication must be reasonable.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Female ; Humans ; Hypertrophy ; surgery ; Ligamentum Flavum ; pathology ; surgery ; Male ; Middle Aged ; Spinal Diseases ; surgery ; Treatment Outcome

OBJECTIVETo investigate the surgical treatment of thoracic ossification of the ligamentum flavum (TOLF) and analysis of the therapeutic effects.

METHODSSix patients with thoracic ossification of the ligamentum flavum were retrospectively studied from October 2006 to October 2009. All of the patients in this group were treated by en bloc hemi-articular process laminectomy. There were 4 males and 2 females, ranging in age from 45 to 66 years, averaged 55.2 years. The evaluate factors including the preoperative and postoperative JOA scores,and the function of the urinary bladder were analyzed.

RESULTSAll the 6 patients were followed after operation. The mean followed-up duration was 10.5 months, ranging from 2 to 18 months. According to JOA evaluation criteria, 4 patients got an excellent result, 1 good and 1 bad. The one patient with bad result had spinal cord compressed for too long time, and the T2-weight MRI showed nonreversible degeneration of spinal cord and combined with schizophrenia. The clinical symptoms improved with varying degrees.

CONCLUSIONThe en bloc hemi-articular process laminectomy is an effective method for ossification of the thoracic ligamentum flavum. A thorough decompression and real-time protection of the spinal cord is the key to the success of surgery.

Aged ; Decompression, Surgical ; Female ; Humans ; Ligamentum Flavum ; pathology ; Male ; Middle Aged ; Ossification, Heterotopic ; surgery ; Postoperative Complications ; etiology ; Retrospective Studies ; Spinal Cord Injuries ; etiology ; Thoracic Vertebrae ; pathology

OBJECTIVETo investigate the prognostic factors for patients with thoracic ossification of the ligamentum flavum (OLF) and thoracic ossification of posterior longitudinal ligament (OPLL).

METHODSClinical information of 83 patients suffering from thoracic OLF and OPLL was reviewed retrospectively from January 2006 to June 2010. The related factors such as gender, age, preoperative and postoperative Japanese Orthopedic Association (JOA) score, pathological segment, type of thoracic OPLL, degree of thoracic kyphosis, anteroposterior diameter of OPLL, range of circumferential decompression, cerebrospinal fluid leakage or not and dysfunction or not and carotid lumbar disorders or not were analyzed by Chi-square and Logistic regression.

RESULTSAll cases were classified into desirable group (58 cases) and undesirable group (25 cases) based on the postoperative JOA score improvement rate. Comparison of physical characteristics between two groups of age, preoperative JOA and the course of the disease had not statistically significant (P > 0.05). Two groups in pathological segment of thoracic OPLL (χ(2) = 6.290, P = 0.043), the ossification type of OPLL (χ(2) = 5.361, P = 0.021) and dysfunction or not in preoperative (χ(2) = 27.711, P = 0.000) had significant difference. Logistic regression analysis showed that the upper thoracic segments (P = 0.044), beak type ossification (P = 0.023) and with dysfunction in preoperative (P = 0.009) were risk factors. There were 24 patients (28.9%) with cerebrospinal fluid leakage, 3 patients with early postoperative deep infection and neurological deterioration of 2 cases in postoperative.

CONCLUSIONSPatients with ossification on the upper section of thoracic have a better prognosis, but the beaked localized longitudinal ligament ossification in patients and associated with preoperative dysfunction show a poor prognosis, combined jumping segmental ossification and cervical or lumbar severe disorders are the influencing factor for poor prognosis.

Adult ; Aged ; Decompression, Surgical ; Female ; Humans ; Ligamentum Flavum ; pathology ; Logistic Models ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; diagnosis ; surgery ; Postoperative Complications ; epidemiology ; Prognosis ; Retrospective Studies

BACKGROUNDOssification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy. This study was to describe a rare clinical entity of spinal cord kinking (SK) in thoracic myelopathy secondary to OLF.

METHODSThe data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively. The incidence and location of SK were determined using preoperative magnetic resonance imaging (MRI). The clinical presentation and radiological characteristics in patients with SK were analyzed. Posterior en bloc laminectomy with OLF was performed, and the surgical results were evaluated.

RESULTSSK was found in seven patients (7.4%) based on preoperative MRI. The patients included one male and six females with an average age of 55.6 years (range, 48-64 years). Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis. In all cases, the kinking was located just above the end of the spinal cord where the conus medullaris (CM) was compressed by the OLF. The degree of SK varied from mild to severe. The tip of the CM was located between the upper third of T11 to the lower third of L1, above the lower edge of L1. With an average follow-up of 30.4 months, the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively (t = 12.05; P < 0.0001) with an improvement rate of 63.1 ± 12.3%.

CONCLUSIONSSK is a rare radiological phenomenon. It is typically located at the thoracolumbar junction, where the CM is compressed by the OLF. Our findings indicate that these patients may benefit from a posterior decompressive procedure.

Female ; Humans ; Ligamentum Flavum ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ossification, Heterotopic ; complications ; Radiography ; Spinal Cord Compression ; diagnosis ; diagnostic imaging ; surgery ; Spinal Cord Diseases ; diagnosis ; diagnostic imaging ; etiology ; surgery