The characteristic features of the Forestier's disease, ankylosing hyperostosis of the spine, consist essentially in marginal proliferation at the vertebral edges which are apt to unit their homologues to form bridges and to extend as a bony layer which thickens the vertebral cortex with an overgrowth of bone spreading like a flow. The disease had been long looked upon as vertebral spondylosis or other spinal diseases such as ankylosing spondylitis before Forestier first defined it as a new disease entity. The bony changes could be occurred everywhere on the spinal column, but are mainly confined to the anterior part of the thoracic spine, especially in the right side. It clinically may be of little significance because of little symptoms. Forestier reported 88% of the patients was over 50 years old and 65% was male of 45 cases. Although the pathogenesis is uncertain, a spinal expression of more diffuse ossifying diathesis may be considered. We are reporting a case of the Forestier's disease which was incidentally found on a 55 years old paraplegic patient who had suffered from back trauma.
Disease Susceptibility ; Humans ; Hyperostosis* ; Hyperostosis, Diffuse Idiopathic Skeletal ; Male ; Middle Aged ; Spinal Diseases ; Spine ; Spondylitis, Ankylosing ; Spondylosis

STUDY DESIGN: Case report. OBJECTIVES: To report a case of progressive kyphotic deformity after spinal fusion in a patient with diffuse idiopathic skeletal hyperostosis (DISH). SUMMARY OF LITERATURE REVIEW: DISH is characterized by spinal and peripheral enthesopathy, and is a completely different disease from ankylosing spondylitis (AS). Though DISH can be associated with thoracic kyphosis, no reports have described a progressive thoracolumbar kyphotic deformity after spinal fusion surgery in a DISH patient. MATERIALS AND METHODS: A 47-year-old male presented with pain in the thoracolumbar region. After excluding the possibility of AS and confirming the diagnosis of DISH, we performed spinal fusion for the treatment of a T11-T12 flexion-distraction injury. The kyphotic deformity was found to be aggravated after the first operation, and we then performed corrective osteotomy and additional spinal fusion. Results: The kyphotic deformity of the patient was corrected after the second operation. RESULTS: The kyphotic deformity of the patient was corrected after the second operation. CONCLUSIONS: In DISH patients in whom AS must be excluded in the differential diagnosis, a kyphotic deformity can become aggravated despite spinal fusion surgery, so regular and continuous follow-up is required.
Congenital Abnormalities* ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal* ; Kyphosis ; Male ; Middle Aged ; Osteotomy ; Rheumatic Diseases ; Spinal Fusion* ; Spondylitis, Ankylosing

STUDY DESIGN: Review article.OBJECTIVES: To assess the evidence for nonoperative treatment of various degenerative spinal degenerative diseases.SUMMARY OF LITERATURE REVIEW: No study has yet evaluated the evidence for preoperative nonoperative treatment of lumbar spinal diseases.METHODS: The evidence regarding nonoperative treatment for each disease was reviewed through NASS guidelines, and the treatment effect compared to surgical treatment was reviewed through the SPORT series. The efficacy of nonoperative treatment according to disease severity and certain special conditions was investigated through corresponding individual articles.RESULTS: No kind of nonoperative treatment could change the fundamental progression of degenerative spinal disease. The natural course of lumbar disc herniation is favorable regardless of treatment. More than 70% of routine cases improve within 6 weeks. However, it does not take a full 6 weeks to decide whether to perform surgery or not. The evidence for transforaminal epidural steroid injections for short-term pain control is grade A. There is grade B evidence for nonoperative treatment with the goal of mid- to long-term pain control. However, we cannot say that those outcomes are better than the natural course of the disease itself. In cases of radicular weakness, the degree of weakness is correlated with the final outcomes, but it is not evident whether the duration of weakness is correlated with surgical outcomes. Early surgery is usually necessary due to intolerable pain, rather than stable motor weakness. The social cost of herniated discs arises from the loss of patients’ productivity, rather than from direct medical expenses. The natural course of spinal stenosis involves provoked pain and the need for palliative care. Unlike disc herniation, rapid deterioration and marked improvement do not occur. The symptoms of mild to moderate lumbar stenosis are unchanged in 70% of cases, improve in 15%, and worsen in 15%. No study has compared nonoperative treatment with the natural course of the disease. There is no evidence for nonoperative treatment of severe stenosis. Epidural spinal injections are effective for controlling short-term pain. Spontaneous recovery of radicular weakness does not occur, and urgent surgery is necessary in such cases. There is no evidence regarding the natural course and nonoperative treatment of degenerative spondylolisthesis. The working group consensus recommends that it should follow the pattern of nonoperative treatment of spinal stenosis when radicular stenosis symptoms are predominant. Overall, 40%–66% of cases of adult bilateral isthmic spondylolysis progress to symptomatic spondylolisthesis. No studies have investigated nonoperative treatment except physical exercise.CONCLUSIONS: Although short-term symptom amelioration can be achieved by nonoperative treatment, the fundamental progression of the disease is not affected. For conditions excluded from most studies, such as prior spine surgery, cauda equina syndrome, progressive neurological deficit, and uncontrollable severe pain associated with instability, deformity, or vertebral fractures, there were not enough studies to reach informed conclusions. Our review found no evidence regarding nonoperative treatment for such conditions. Furthermore, the treatment methods for each disease are not clearly distinguished from each other, and the techniques used for disc herniation have been applied to other diseases without any evidence.
Adult ; Congenital Abnormalities ; Consensus ; Constriction, Pathologic ; Efficiency ; Exercise ; Humans ; Injections, Spinal ; Intervertebral Disc Displacement ; Palliative Care ; Polyradiculopathy ; Spinal Diseases ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Spondylolysis ; Sports

There are several modalities of surgical treatment in lumbar herniated nucleus pulposus (HNP), derangement of lumbar intervertebral disk (DLID), spondylolysis, spondylolisthesis and degenerative spinal stenosis with scoliosis, such as laminectomy, laminectomy and diskectomy, laminectomy with diskectomy and posterolateral fusion, laminectomy with diskectomy and posterior lumbar intebody fusion, anterior diskectomy and interbody fusion, modification with cage instrumentation and decompression with instrumentation and posterolateral fusion. Low back pain due to the instability resulting from the removal of the nucleus pulposus was not infrequent in clinical practice. The purpose of the study was to determine the factors affecting clinical results by evaluating fusion rate, fusing pattern, measurement of spinal canal, correction of deformity. Five hundred and twenty eight cases of lower lumbar spinal diseases including 2S6 cases of lumbar HNP and DLID, 189 cases of spondylolysis and spondylolisthesis and 53 cases of spinal stenosis with scoliosis were studied respectively. The cases were admitted to Severance Hospital department of Orthopaedic Srugery from January 1970 through December 1994, and followed the patients from two years up to 15 years with an average of 2.9 years. It was reviewed clinical records and radiographs. The radiological study included plain x-ray, dynamogram, tomogram, myelography, computed axial tomography and/or MRI. It was evaluated the fusion rate, fusing pattern, area of spinal canal, correction of deformity and clinical results. The rate of solid fusion was 89.5% in lumbar HNP and DLID, 77.3% in spondylolysis and spondy-lolisthesis, and 86.7% in spinal stenosis with scoliosis. The most common type of the fusing pattern was type I in lower lumbar diseases. The satisfying clinical result was 82.6% in lumbar HNP and DLID, 76.7% in spondylolysis and spondylolisthesis and 58.5% in spinal stenosis with scoliosis. Spinal canal measurement was done in 23 cases and the increase of A-P diameter of spinal canal was 0.50+/-0.29mm and it was correlated with satisfying clinical result. Correction of the deformity was evaluated in 53 cases of spinal stenosis with scoliosis and of them 67.9% was corrected and it was correlated with satisfying clinical result. In conclusion the factors affecting the satisfying clinical results in the lower lumbar spinal diseases treated by diskectomy and anterior interbody fusion are solid union, restoration of disk height, correction of the deformity and increment of area of dural sac. Anterior diskectomy and interbody fusion have shown to be a good method of treatment for lower lumbar spinal diseases.
Congenital Abnormalities ; Decompression ; Diskectomy ; Hospital Departments ; Humans ; Intervertebral Disc ; Laminectomy ; Low Back Pain ; Magnetic Resonance Imaging ; Myelography ; Scoliosis ; Spinal Canal ; Spinal Diseases* ; Spinal Stenosis ; Spondylolisthesis ; Spondylolysis

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Pathologic changes occurred in patients with AS result in a weakened vertebral column with increased susceptibility to fractures, even though a trivial injury. Fractures usually tends to involve the lower cervical spine, but rarely, they are also occurred in thoracolumbar spine. We present our experiences of three cases of spinal fracture in patients with AS, cervical, thoracic, and lumbar spine, with a review of literatures.
Humans ; Rheumatic Diseases ; Spinal Fractures ; Spine ; Spondylitis ; Spondylitis, Ankylosing

The aim of the spine fusion is to obtain the stability of the spine. Spinal fusion have been used for the treatment of tuberculosis and arrest of the progress of spinal deformity such as scoliosis. Nowadays the spine fusion is used often in conditions which present the instability; spondylosis, spondylolisthesis and the unstable postlaminectomy spine. Unilateral posterolateral fusion plus hemiposterior fusion were done only in the cases who had wide hemilaminectomy, while in rest of cases bilateral posterolateral fusion was indicated in this series. Fifty-two cases, treated with posterolateral lumber fusion during the period from June 1980 to Dec. 1985, were analysed clinically and radiologically and the following results were obtained. l. Among the 52 cases, 25 cases(48.1%) were male; and 27 cases(51.9%) were female; The youngest was 16 years of age and the oldest one was 63 years of age. Average age of the patient was 39.6 years. 2. Fifteen patients had spinal stenosis, 14 cases of spondylolisthesis, 11 cases of H.N.P., 6 cases of spondylolysis, 4 cases of tuberculous spondylitis and 2 cases of fracture-dislocation of lumbar spine. 3. As a method immobilization after operation, postoperatively hips spica cast was applied in 4 cases for 12 weeks, Norton-Brown back brace in 9 cases following 6 weeks of posloperative hip spica cast immobilization and Norton-Brown brace 39 cases following 2 weeks of postoperative bed rest. 4. In 41 cases bilateral posterolateral fusion was done, and in 11 cases unilateral posterolateral fusion plus hemiposterior fusion were done. The bony union was established within 4 months after bilateral posterolateral fusion in 37 cases and after unilateral posterolateral fusion in 9 cases. In 2 cases complete union was obtained within 6 months after fusion. 5. The union rate was 92.7% in bilateral posterolateral fusion and 90.9% in unilateral posterolateral fusion. There was no significant differences of the union rate between bilateral and unilateral fusion groups. Therefore, the unilateral posterolateral fusion is a suitable method in the treatment of mild spinal instability regardless of its causes. The procedure has benefits, such as short operation time, less blood loss, and less surgical burden to the patient.
Arthrodesis ; Bed Rest ; Braces ; Clinical Study ; Congenital Abnormalities ; Female ; Hip ; Humans ; Immobilization ; Male ; Methods ; Scoliosis ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylitis ; Spondylolisthesis ; Spondylolysis ; Spondylosis ; Tuberculosis

Morphologically, kyphosis is devided into two groups, pure kyphosis and kyphoscoliosis, according to whether or not scoiiosis is combined. Or kyphosis can be devided into round kyphosis or angular kyphosis. The examples of round kyphosis are Scheuermanns kyphosis or ankylosing spondylitis. Acute angular kyphosis are of congenital kyphosis or old healed tuberculosis. The purpose of surgical correction of fixed kyphosis is to correct deformity as well as to prevent or to recover from paraplegia. The operation also improve respiratory and digestive function by diminishing compression of abdomen. However, the correction of this deformity is more dangerous in eliciting paraplegia than any other spinal deformity. In considering surgical correction of kyphosis we have to decide which approach is the best for that particular patient at that particular time. Usually majority of patient need combined anterior and posterior approach. The extent of fusion depends upon the flexibility of the kyphosis. Anterior fusion should encompass at least the rigid and inflexible portion of the kyphosis as determined by the hyperextension x-ray of the spine. Posterior fusion should encompass the full extent of the kyphosis. The purpose of this study is to report our results for surgical correction and to find the operative procedure which shows the best result. We hereby report surgically corrected 14 cases of fixed kyphosis who were hospitalized here from April 1988 to February 1995.
Abdomen ; Congenital Abnormalities ; Humans ; Kyphosis* ; Paraplegia ; Pliability ; Scheuermann Disease ; Spine ; Spondylitis, Ankylosing ; Surgical Procedures, Operative ; Tuberculosis

Bilateral pedicle stress fracture is a rare entity and few cases have been reported in the literature. Furthermore, the majority of these reports concern previous spine surgery or stress-related activities. Here, the authors report ankylosing spondylitis as a new cause of bilateral pedicle stress fractures accompanying spondylolysis. The reported case adds to the literature on bilateral pedicle stress fracture and spondylolysis by documenting that ankylosing spondylitis is another cause of this condition.
Fractures, Stress ; Humans ; Spine ; Spondylitis, Ankylosing ; Spondylolysis

Foreatiers disease is a peculiar type of ankylosing hyperostosis of the spine characterized by ossification of the anterior and right lateral aspects of the vertebral column, particularly in the thoracic region. The clinical, pathological and reontgenographic features of the disorder allowed its differentiation from other spinal diseases including ankylosing spordylitis and osteoarthritis. A case of Forestiers disease is presented with brief review of literatures.
Hyperostosis ; Hyperostosis, Diffuse Idiopathic Skeletal ; Osteoarthritis ; Spinal Diseases ; Spine

OBJECTIVE: The aim of the present study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases. METHODS: The study population included 20 consecutive patients (13 females, 7 males) with a mean age of 61+/-6.98 years (range 46-70) who underwent decompression and dynamic stabilization with the Dynesys system between January 2005 and August 2006. The diagnoses included spinal stenosis with degenerative spondylolisthesis (9/20, 45%), degenerative spinal stenosis (5/20, 25%), adjacent segmental disease after fusion (3/20, 15%), spinal stenosis with degenerative scoliosis (2/20, 10%) and recurrent intervertebral lumbar disc herniation (1/20, 5%). All of the patients completed the visual analogue scale (VAS) and the Korean version of the Oswestry Disability Index (ODI). The following radiologic parameters were measured in all patients : global lordotic angles and segmental lordotic angles (stabilized segments, above and below adjacent segments). The range of motion (ROM) was then calculated. RESULTS: The mean follow-up period was 27.25+/-5.16 months (range 16-35 months), and 19 patients (95%) were available for follow-up. One patient had to have the implant removed. There were 30 stabilized segments in 19 patients. Monosegmental stabilization was performed in 9 patients (47.3%), 9 patients (47.3%) underwent two segmental stabilizations and one patient (5.3%) underwent three segmental stabilizations. The most frequently treated segment was L4-5 (15/30, 50%), followed by L3-4 (12/30, 40%) and L5-S1 (3/30, 10%). TheVAS decreased from 8.55+/-1.21 to 2.20+/-1.70 (p<0.001), and the patients' mean score on the Korean version of the ODI improved from 79.58%+/-15.93% to 22.17%+/-17.24% (p<0.001). No statistically significant changes were seen on the ROM at the stabilized segments (p=0.502) and adjacent segments (above segments, p=0.453, below segments, p=0.062). There were no patients with implant failure. CONCLUSION: The results of this study show that the Dynesys system could preserve the motion of stabilized segments and provide clinical improvement in patients with degenerative spinal stenosis with instability. Thus, dynamic stabilization systems with adequate decompression may be an alternative surgical option to conventional fusion in selected patients.
Decompression ; Female ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Scoliosis ; Spinal Diseases ; Spinal Stenosis ; Spine ; Spondylolisthesis