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

Humans ; Osteogenesis ; Mesentery/surgery* ; Ossification, Heterotopic/surgery*

Acetabulum/surgery* ; Arthroplasty, Replacement, Hip/adverse effects* ; Femur Head Necrosis/surgery* ; Fracture Fixation, Internal ; Fractures, Bone/surgery* ; Hip Fractures/surgery* ; Humans ; Ossification, Heterotopic/surgery* ; Treatment Outcome

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

A 8-years-old male patient with a bulge of left eye ball for one mongth was hospitalized. The inspection of the patient showed the movement on the left side of the lateral nasal wall and a narrow nasal cavity. Orbital CT showed that the left orbital ethmoid sinus, maxillary sinus cyst, left orbital, sphenoid sinus, nasal cavity were damaged. A resection with the combination of approaches including the left maxillary sinus, the ethmoid sinus, and the sphenoid sinus osteofibroma was performed. 5 days after the operation, the nasal packing material was removed and 7 days after the operation the stiches were removed. The recovery of the patient was satisfied after the operation and no recurrence was observed during one and half years follow up.
Child ; Ethmoid Sinus ; pathology ; Humans ; Male ; Maxillary Sinus ; pathology ; Nasal Cavity ; pathology ; Nasal Surgical Procedures ; Ossification, Heterotopic ; diagnosis ; surgery ; Paranasal Sinus Diseases ; diagnosis ; surgery ; Sphenoid Sinus ; pathology

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

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

Child ; Child, Preschool ; Cochlea ; surgery ; Cochlear Implantation ; methods ; Female ; Humans ; Infant ; Male ; Ossification, Heterotopic ; surgery

OBJECTIVE: The purpose of this study is to report surgical skills for CI cases with modiolus ossification and to investigate the relation between post-operational electroneurophysilogical test result and speech recognition result. Further more, we also attempt to confirm indications for CI in this specific population. METHOD: Based on temporal bone HRCT, 7 subjects were identified as modiolus ossification from 101 cases with cochlear ossification. Modiolus ossification is confirmed by CT scan if CT value in modiolus reaches or exceeds 900 HU with the exception of congenital modiolus ossification or modiolus seal off. Electroneurophysiological test was conducted intra- and pos-operationally speech tests were applied for 7 subjects. RESULT: Normal impedance value was observed by intro-operational measurement in 7 subjects. EABR test was conducted and negtive response was observed in only 1 subject, while other 6 subjects were confirmed with atypical EABR waves which were observed in apical and middle turn region. Hearing threshold test (in sound field) was applied, no auditory response was recorded for the subject without EABR waveform, while hearing threshold in average for the other 6 subjects was 75 dB. Results of speech tests (Mandarin) were followed as 0 for the one without EABR wave, while 100% (simple finals test) and 30% (simple initials test) for the other 6 subjects. CONCLUSION Optimal multichannel CI surgery that inserting and locating electrode array spirally is very frequently interrupted by ossification,which was indentified with atypical EABR wave and relative poor speech recognition results, especially in modiolus ossification case. A post-operative negative EABR response may indicate surgical failure following cochlear implantation.
Adolescent ; Adult ; Child ; Child, Preschool ; Cochlea ; pathology ; Cochlear Implantation ; Evoked Potentials, Auditory, Brain Stem ; physiology ; Female ; Humans ; Infant ; Male ; Middle Aged ; Ossification, Heterotopic ; surgery ; Postoperative Period ; Young Adult

OBJECTIVE: To investigate the guiding function of three-dimensional CT scan in the operation of eagle syndrome. METHOD: There were 48 cases of eagle syndrome hospitalized during July 2006 to June 2010 who underwent both three-dimensional reconstruction of CT scan and adem position and lateral X ray film. The images were measured by specialist of radiology department. RESULT: The detail of styloid process is showed more precisely by three-dimensional CT scan, which is able to determine the existence of interrupt, decline, ossification in styloid process. There was significant difference in the measured value (20.83%) between X ray and CT scan (4.16 ± 1.27)cm vs (3.11 ± 0.62)cm, P < 0.05, in 10 cases. We could not touch styloid process in oral approach in 6 cases (12. 5%), which also had diagnostic confliction between X ray and three-dimensional CT scan. Five patients whose styloid process could not be touched during surgery had longer operation time than the other 41 patients. CONCLUSION Three-dimensional CT has good repeatability, high detailed distinguishability, which is an important basis to diagnose eagle syndrome. When X ray shows prolonged styloid process which can not be palpable in oral, we suggest further three-dimensional CT to avoid unnecessary surgery.
Female ; Humans ; Imaging, Three-Dimensional ; Male ; Ossification, Heterotopic ; diagnostic imaging ; surgery ; Temporal Bone ; abnormalities ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed