OBJECTIVE: To explore short-term effectiveness of floating island laminectomy surgery in treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum. METHODS: A total of 31 patients with thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum between January 2019 and April 2022 were managed with floating island laminectomy surgery. The patients comprised 17 males and 14 females, aged between 36 and 78 years, with an average of 55.9 years. The duration of symptoms of spinal cord compression ranged from 3 to 62 months (mean, 27.2 months). The lesions affected T _1-6 in 4 cases and T _7-12 in 27 cases. The preoperative neurological function score from the modified Japanese Orthopaedic Association (mJOA) was 4.7±0.6. Surgical duration, intraoperative blood loss, and complications were recorded. The thoracic MRI was conducted to reassess the degree of spinal cord compression and decompression after operation. The mJOA score was employed to evaluate the neurological function and calculate the recovery rate at 12 months after operation. RESULTS: The surgical duration ranged from 122 to 325 minutes, with an average of 204.5 minutes. The intraoperative blood loss ranged from 150 to 800 mL (mean, 404.8 mL). All incisions healed by first intention after operation. All patients were followed up 12-14 months, with an average of 12.5 months. The patients' symptoms, including lower limb weakness, gait disorders, and pain, significantly improved. The mJOA scores after operation significantly increased when compared with preoperative scores ( P<0.05), gradually improving with time, with significant differences observed among 1, 3, and 6 months ( P<0.05). The recovery rate at 12 months was 69.76%±11.38%, with 10 cases exhibiting excellent neurological function and 21 cases showing good. During the procedure, there were 3 cases of dural tear and 1 case of dural defect. Postoperatively, there were 2 cases of cerebrospinal fluid leakage. No aggravated nerve damage, recurrence of ligamentum flavum ossification, or postoperative thoracic deformity occurred. CONCLUSION The floating island laminectomy surgery is safe for treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum, effectively preventing the exacerbation of neurological symptoms. Early improvement and recovery of neurological function are achieved.
Humans ; Male ; Spinal Stenosis/diagnostic imaging* ; Female ; Laminectomy/methods* ; Ligamentum Flavum/pathology* ; Middle Aged ; Aged ; Thoracic Vertebrae/surgery* ; Adult ; Decompression, Surgical/methods* ; Treatment Outcome ; Ossification, Heterotopic/surgery* ; Spinal Cord Compression/etiology* ; Spinal Cord Diseases/etiology* ; Magnetic Resonance Imaging

BACKGROUND: Heterotopic ossification (HO) is a known complication of hip arthroscopy. We investigated incidence of HO after hip arthroscopy and determined whether revision for HO improved outcome. METHODS: A retrospective study was conducted on 242 patients (140 men and 102 women, mean age: 36.2 ± 9.5 years) who underwent hip arthroscopy for femoroacetabular impingement (FAI) between January 2016 and January 2018. The average follow-up period was 22.88 ± 11.74 months (range: 11-34 months). Thirteen (5.37%) cases of HO (six men and seven women, five left hips and eight right hips; mean age: 37.5 ± 4.7 years) were observed. Among them, four cases with HO with obvious pain symptoms and persistent non-remission underwent revision surgery to remove HO. Monthly follow-up was conducted. Visual analog scale (VAS), modified Harris Hip Score (mHHS), and non-Arthritis Hip Score (NAHS) were evaluated and compared between HO and non-HO patients. Independent sample t test, Mann-Whitney U test and the Chi-square test were used for inter-group comparisons. HO degree was evaluated using Brooker classification. Symptoms and function were evaluated before and after revision. RESULTS: A total of 242 patients were involved in this study. Thirteen cases (5.4%) had imaging evidence of HO. Nine (9/13) were classified as Brooker stage I, three (3/13) Brooker stage II, and one (1/13) Brooker stage III. HO was detected by ultrasonography as early as 3 weeks after operation. After primary surgery, the mHHS of the HO group and non-HO group increased by 13.00 (8.50, 25.50) and 24.00 (14.00, 34.50) points (Z = -1.80, P = 0.08), NAHS increased by 18.00 (9.50, 31.50) and 26.00 (13.50, 36.00) points (Z = -1.34, P = 0.18), and VAS decreased by 3.00 (2.00, 4.00) and 4.00 (3.00, 4.50) points (Z = -1.55, P = 0.12). Average follow-up time after revision was 9.00 ± 2.94 months; mHHS increased by 34.75 points (t = -55.23, P < 0.01) and NAHS by 28.75 points (t = -6.03, P < 0.01), and VAS decreased by 4 points (t = 9.80, P < 0.01). HO and non-HO patients were similar for demographic and surgical data, and clinical and functional scores. CONCLUSION HO incidence after arthroscopic treatment of FAI is similar to that found in previous studies. Most HO have no effect on clinical symptoms. Patients who undergo revision HO resection show improvement in pain and joint function.
Adult ; Arthroscopy ; adverse effects ; Female ; Femoracetabular Impingement ; surgery ; Hip Joint ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Ossification, Heterotopic ; diagnosis ; etiology ; Retrospective Studies ; Treatment Outcome

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

Heterotopic calcification following head and neck irradiation has rarely been reported. It usually develops as a late complication of radiotherapy in patients with malignancies, including breast cancer, lymphoma, and genitourinary malignancies. The occurrence of heterotopic calcification in the prevertebral space of the cervical spine has not been described as a late complication of irradiation. Here, we report a case of prevertebral heterotopic calcification in a patient with history of chemotherapy and radiotherapy for tonsil cancer 21 years ago.
Aged ; Calcinosis/*etiology/pathology/radiography ; *Cervical Vertebrae/radiography ; Female ; Humans ; Ossification, Heterotopic/*etiology/radiography ; Radiation Injuries/complications ; Tomography, X-Ray Computed ; Tonsillar Neoplasms/*radiotherapy

BACKGROUNDCervical disc replacement (CDR) as a substitute for traditional fusion surgery has been widely used in treating degenerative cervical disc diseases. The objectives of this study were to assess the clinical and radiological findings for patients with heterotopic ossification (HO) following CDR and to detect the risk factors of HO after CDR.

METHODSA total of 125 patients with symptomatic cervical single- or double-level disc diseases, who underwent CDR procedure with Discover prosthesis in Department of Spine Surgery, Changzheng Orthopedics Hospital from March 2009 to March 2011, were enrolled in this retrospective study. Occurrence of HO was defined by the McAfee classification on cervical lateral X-rays in this study. Prosthesis vertebral ratio (PVR) was used to determine the matching degree between the cervical disc prosthesis and cervical vertebra. Logistic regression analyses were performed to determine the risk factors of HO. Variables evaluated for their association with HO occurrence included age, gender, high-intensity signal in spinal cord, preoperative range of motion (ROM), postoperative ROM, operation level number, and PVR.

RESULTSMean follow-up time was (26.4±5.8) months. All the patients had significant symptoms and neurological function improvements during the follow-up period. The ROM of the operated segment from the preoperative period to the last follow-up was relatively well maintained. The rate of HO in this cohort of patients, who underwent Discover disc, was 27.92% per surgical level and 24.8% per patient by the last follow-up. There were 19 patients (19.79%) with HO in the single-level group while 12 patients (41.38%) in the double-level group.

CONCLUSIONSWe identified preoperative high-intensity signal in spinal cord, postoperative ROM of surgical level, number of operation level, and PVR as significant risk factors for postoperative HO occurrence.

Adult ; Cervical Vertebrae ; surgery ; Female ; Humans ; Male ; Middle Aged ; Ossification, Heterotopic ; epidemiology ; etiology ; Retrospective Studies ; Risk Factors ; Total Disc Replacement ; adverse effects

Heterotopic ossification (HO) is the aberrant formation of ectopic bone within the soft tissues, of which the aetiology is usually either traumatic or neurogenic. Neurogenic HO is a known but uncommon complication that occurs after a cerebral or spinal insult. The condition may present with a spectrum of symptoms and is often difficult to diagnose clinically. Although different imaging modalities have been used to diagnose HO, clinicians and radiologists may occasionally encounter radiological features of HO that may mimic other disease conditions. We herein report a rare case of neurogenic HO occurring in the non-paretic limb of a patient, and the diagnostic and radiological challenges encountered.
Analgesics ; therapeutic use ; Contrast Media ; chemistry ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Ossification, Heterotopic ; diagnosis ; etiology ; Quality of Life ; Radiographic Image Interpretation, Computer-Assisted ; Stroke ; complications ; Tomography, X-Ray Computed

OBJECTIVE: To investigate cochlear implantation surgical techniques and postoperative results in patients with cochlear ossification. METHOD: Twenty-nine cochlear ossification patients with cochlear implantation in our department were retrospectively studied during 1997-2011. Preoperative imaging and electrophysiological assessment were done to classify the cochlear ossification of all the patients. Categories of auditory performance and speech intelligibility rating were detected to assess the outcome of cochlear implant postoperatively. RESULT: Among 29 cases with cochlear ossification, 19 cases were grade II, 4 cases were grade I, 4 cases were grade III, and 2 cases were apical turn ossification. Among 23 patients with cochlear ossification grade I and II, 17 cases were totally cochlear array insertion, and 6 cases were partial cochlear array insertion. Patients with cochlear ossification grade III were all partial cochlear array insertion. Most patients achieved good hearing and language ability after cochlear implantation. CONCLUSION Cochlear implantation can be successfully performed on the basis of systematic preoperative assessment and some patients can achieve good postoperative results in patients with cochlear ossification. Intraoperative electrical stimulation of the auditory evoked response provides a good method to assess the residual spiral nerve function.
Adolescent ; Adult ; Child ; Child, Preschool ; Cochlea ; pathology ; Cochlear Implantation ; methods ; Female ; Follow-Up Studies ; Hearing Loss, Sensorineural ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Ossification, Heterotopic ; complications ; Retrospective Studies ; Treatment Outcome ; Young Adult

Abdominal Wall ; pathology ; Humans ; Male ; Mesentery ; pathology ; Middle Aged ; Ossification, Heterotopic ; etiology ; Postoperative Complications ; etiology ; Tomography, X-Ray Computed

OBJECTIVETo study the pathogenesis and treatment of gluteal heterotopic ossification caused by injection.

METHODSFrom April 2006 to May 2011, 4 old female patients with gluteal heterotopic ossification caused by injection were treated by resection. The average age was 71 years old ranging from 67 to 76. The illness were bilateral,the clinical character was pain and hard nodules in the both hip. The X-ray, CT and pathology matched the diagnosis of heterotopic ossification. Two of them were treated by totally removing the ossified tissues, and loosing the spastic and adhesive soft tissues. The other two were treated with local resection and soft-tissue lysis.

RESULTSThe wound of all patients healed well, and there were no complication. All patients were followed-up from 2 to 64 months(averaged 26 months). There were no lump and pain in the location of surgical resection.

CONCLUSIONGluteal heterotopic ossification caused by injection is the drug reaction produced by injecting benzyl alcohol or other drugs,and happens in adults. The key for the treatment is to remove part or all of the painful lump,and loose the local fascia and other soft tissues of the gluteal muscles.

Aged ; Buttocks ; Female ; Humans ; Injections, Intramuscular ; adverse effects ; Ossification, Heterotopic ; etiology ; surgery

A lipogranuloma is an inflammatory reactive process associated with exogenous or endogenous lipids, and it's occurrence in the breast has rarely been reported. Osseous metaplasia, which is used to describe bone formation in abnormal locations, can develop from several conditions such as trauma or a tumor. However, few studies have reported benign breast lesions that have been seen as osseous metaplasia. We present a case of a benign calcified breast lesion that developed after a traumatic treatment process called "Bu-Hwang", and it was confirmed as a lipogranuloma with osseous metaplasia. To the best of our knowledge, this is the first reported case of a lipogranuloma with osseous metaplasia in the breast.
Aged ; Breast/*pathology ; Female ; Granuloma/*etiology/pathology ; Humans ; Mammography ; Medicine, East Asian Traditional/*adverse effects ; Metaplasia ; Ossification, Heterotopic/*etiology ; Osteocytes/pathology