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Zhu Z, He Z, Tang T, Wang F, Chen H, Zhou J, Lin C, Chen G, Wang J, Li J, Liu X, Zhou Z, Liu S. Effect of mechanical stimulation on tissue heterotopic ossification: an in vivo experimental study. Front Physiol 2023; 14:1225898. [PMID: 37900947 PMCID: PMC10600381 DOI: 10.3389/fphys.2023.1225898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
Background: Heterotopic ossification of tendons and ligaments (HOTL) is a common clinical condition characterized by the absence of discernible features and a lack of effective treatment. In vitro experiments have demonstrated that mechanical stimulation can induce cell differentiation toward osteogenesis, thereby promoting heterotopic ossification. Currently, there are few experimental designs aimed at inducing ligament stretching in mice, and the mechanism of heterotopic ossification may not entirely mirror that observed in clinical cases. Therefore, there is an urgent imperative to develop a novel and feasible animal model. Methods: In this study, all the Enpp1 gene deficiency mice (a mouse model with heterotopic ossification of multiple ligaments) were divided into three groups: the control group, the spinal brake group, and the hyperactive group (treadmill training group). An external spinal fixation device was designed to restrict mice's spinal flexion and extension at 6 weeks of age. The brace was adjusted weekly according to the changes in the size of the mice. Additionally, treadmill training was used to increase activity in the spinal ligaments and Achilles tendons of the mice. Micro-CT scanning and HE staining were performed at 12, 20, and 28 W to evaluate the degree of ossification in the spinal ligament and Achilles tendon. What's more, As one of the mechanical stimulation transduction signals, YAP plays a crucial role in promoting osteogenic differentiation of cells. Immunofluorescence was utilized to assess YAP expression levels for the purpose of determining the extent of mechanical stimulation in tissues. Results: Our findings showed that a few ossification lesions were detected behind the vertebral space of mice at 8 weeks of age. Spinal immobilization effectively restricts the flexion and extension of cervical and thoracic vertebrae in mice, delaying spinal ligament ossification and reducing chronic secondary spinal cord injury. Running exercises not only enhance the ossification area of the posterior longitudinal ligament (PLL) and Achilles tendons but also exacerbate secondary spinal cord injury. Further immunofluorescence results revealed a notable increase in YAP expression levels in tissues with severe ossification, suggesting that these tissues may be subjected to higher mechanical stimulation. Conclusion: Mechanical stimulation plays a pivotal role in the process of heterotopic ossification in tissues. Our study provided valid animal models to further explore the pathological mechanism of mechanical stimulation in HOTL development.
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Affiliation(s)
- Zhengya Zhu
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhongyuan He
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tao Tang
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fuan Wang
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongkun Chen
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jiaxiang Zhou
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chengkai Lin
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Guoliang Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jianmin Wang
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jianfeng Li
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xizhe Liu
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhiyu Zhou
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaoyu Liu
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Li C, Zha G, Yang Z, Pang Y, Qiu S, Fan W, Liu Y, Jiang W. K-line in patients with cervical ossification of the posterior longitudinal ligament: relationship with change in sagittal cervical curvature and laminoplasty outcomes. Arch Orthop Trauma Surg 2022; 142:1743-1751. [PMID: 33555403 DOI: 10.1007/s00402-020-03741-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To analyze how K-line is related to change in sagittal cervical curvature and laminoplasty outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL). MATERIALS AND METHODS The study retrospectively analyzed 81 patients with OPLL who had undergone posterior cervical single-door laminoplasty and arch plate fixation between June 2011 and June 2017. Fifty-five were K-line positive (K[+]) and 26 were K-line negative (K[-]). Clinical and radiological results were compared between the groups. Patients were followed up for at least 2 years. RESULTS Before the operation, Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), and short-form-36 (SF-36) quality of life score did not differ significantly between the groups. Neurological function was improved in both groups after the procedure. At last follow-up, JOA score, VAS score, NDI, SF-36 score, and JOA score improvement rate differed significantly between the groups. Before the operation, at the 3-month and final follow-ups, C2-7 Cobb angle, T1 slope, and C2-7 SVA differed significantly between the groups. The changes were more marked in the K(-) group than in the K(+) group. The incidence of cervical kyphosis differed significantly between the groups (P < 0.05), as well as between patients with lordosis < 7° and those with lordosis ≥ 7°. CONCLUSIONS K-line negativity and lordosis < 7° may predict kyphosis after laminoplasty in patients with OPLL. The cervical curvature in patients with OPLL tends towards kyphosis and anteversion after laminoplasty, which contributes to the reduced clinical effect of the procedure.
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Affiliation(s)
- Cheng Li
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China
| | - Guochun Zha
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Zhi Yang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Yong Pang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Shang Qiu
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Wei Fan
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China
| | - Yijie Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China
| | - Weimin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, Jiangsu Province, China.
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Chikuda H. The Essence of Clinical Practice Guidelines for Ossification of Spinal Ligaments, 2019: 3. Diagnosis of OPLL. Spine Surg Relat Res 2021; 5:325-327. [PMID: 34708166 PMCID: PMC8502510 DOI: 10.22603/ssrr.2021-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gumma University, School of Medicine, Gunma, Japan
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Funaba M, Imajo Y, Suzuki H, Nishida N, Nagao Y, Sakamoto T, Fujimoto K, Sakai T. The associations between radiological and neurological findings of degenerative cervical myelopathy: radiological analysis based on kinematic CT myelography and evoked potentials of the spinal cord. J Neurosurg Spine 2021:1-12. [PMID: 34243153 DOI: 10.3171/2020.11.spine201626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurological and imaging findings play significant roles in the diagnosis of degenerative cervical myelopathy (DCM). Consistency between neurological and imaging findings is important for diagnosing DCM. The reasons why neurological findings exhibit varying sensitivity for DCM and their associations with radiological findings are unclear. This study aimed to identify associations between radiological parameters and neurological findings in DCM and elucidate the utility of concordance between imaging and neurological findings for diagnosing DCM. METHODS One hundred twenty-one patients with DCM were enrolled. The Japanese Orthopaedic Association (JOA) score, radiological parameters, MRI and kinematic CT myelography (CTM) parameters, and the affected spinal level (according to multimodal spinal cord evoked potential examinations) were assessed. Kinematic CTM was conducted with neutral positioning or at maximal extension or flexion of the cervical spine. The cross-sectional area (CSA) of the spinal cord, dynamic change in the CSA, C2-7 range of motion, and C2-7 angle were measured. The associations between radiological parameters and hyperreflexia, the Hoffmann reflex, the Babinski sign, and positional sense were analyzed via multiple logistic regression analysis. RESULTS In univariate analyses, the upper- and lower-limb JOA scores were found to be significantly associated with a positive Hoffmann reflex and a positive Babinski sign, respectively. In the multivariate analysis, a positive Hoffmann reflex was associated with a higher MRI grade (p = 0.026, OR 2.23) and a responsible level other than C6-7 (p = 0.0017, OR 0.061). A small CSA during flexion was found to be significantly associated with a positive Babinski sign (p = 0.021, OR 0.90). The presence of ossification of the posterior longitudinal ligament (p = 0.0045, OR 0.31) and a larger C2-7 angle during flexion (p = 0.01, OR 0.89) were significantly associated with abnormal great toe proprioception (GTP). CONCLUSIONS This study found that the Hoffmann reflex is associated with chronic and severe spinal cord compression but not the dynamic factors. The Babinski sign is associated with severe spinal cord compression during neck flexion. The GTP is associated with large cervical lordosis. These imaging features can help us understand the characteristics of the neurological findings.
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Funaba M, Imajo Y, Suzuki H, Nishida N, Nagao Y, Sakamoto T, Fujimoto K, Sakai T. Impact of various MRI signal intensity changes on radiological parameters, the neurological status, and surgical outcomes in degenerative cervical myelopathy. Clin Neurol Neurosurg 2021; 207:106802. [PMID: 34273664 DOI: 10.1016/j.clineuro.2021.106802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/19/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN A retrospective study of prospectively collected date. PURPOSE The present study aimed to identify patient characteristics, radiological factors, the neurological status, and postoperative outcomes associated with MRI signal intensity changes in degenerative cervical myelopathy (DCM). MATERIAL AND METHOD One hundred and fourteen DCM patients who underwent posterior decompression surgeries were enrolled. Pre- and postoperative (12 months) Japanese Orthopedic Association (JOA) scores, cervical alignment and balance on X rays, the cross-sectional area of the spinal cord (CSA) in kinematic CT myelography (CTM). The recovery rate (RR) of the total JOA score and those specific for the upper and lower limb items were evaluated. MRI included T1-weighted imaging (WI) and T2WI. Patients were classified into two groups for a univariate analysis according to the presence or absence of a high signal intensity (HIS) in the sagittal view on T2WI, a low signal intensity (LSI) in the sagittal view on T1WI, the distribution of HSI at a single or multiple levels, and the presence or absence of the snake eye appearance. A multiple logistic regression analysis (MLRA) was performed to identify factors associated with signal intensity changes on MRI. RESULTS Ninety-six patients (84.3%) were classified into HIS changes in the sagittal view on T2WI. The group with multilevel HSI showed significantly lower RR specific for the lower extremity JOA score (30.8% vs 47.7%; P = 0.016). The snake eye-positive group showed a significantly inferior RR specific for the upper extremity JOA score (40.1% vs 53.2%; P = 0.04). In MLRA, LSI changes on T1WI revealed small CSAF (P = 0.02, Odds ratio; 0.77, 95%CI:0.61-0.97), while HSI changes on T2WI revealed a small CSAF (P = 0.008, Odds ratio;1.36, 95%CI:1.08-1.72) and large C2-7 angle during extension (P = 0.009, Odds ratio;0.73, 95%CI:0.58-0.92). CSAF correlated with multilevel HSI changes (P = 0.006, Odds ratio;0.78, 95%CI:0.66-0.93). The snake eye appearance correlated with CSAF (P = 0.006, Odds ratio;0.78, 95%CI:0.66-0.93) and the duration of disease (P = 0.05, Odds ratio;1.01, 95%CI:1.0-1.03). CONCLUSION Severe and poorly compensated spinal cord compression during neck flexion may cause signal intensity changes. The snake eye appearance may be useful as a sign of the inferior postoperative recovery of upper limb function, and multilevel HSI as a sign of the inferior postoperative recovery of lower limb function.
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Affiliation(s)
- Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
| | - Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yuji Nagao
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takuya Sakamoto
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kazuhiro Fujimoto
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Lee SH, Son DW, Shin JJ, Ha Y, Song GS, Lee JS, Lee SW. Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty. J Korean Neurosurg Soc 2021; 64:677-692. [PMID: 34044492 PMCID: PMC8435653 DOI: 10.3340/jkns.2020.0294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022] Open
Abstract
Many studies have focused on pre-operative sagittal alignment parameters which could predict poor clinical or radiological outcomes after laminoplasty. However, the influx of too many new factors causes confusion. This study reviewed sagittal alignment parameters, predictive of clinical or radiological outcomes, in the literature. Preoperative kyphotic alignment was initially proposed as a predictor of clinical outcomes. The clinical significance of the K-line and K-line variants also has been studied. Sagittal vertical axis, T1 slope (T1s), T1s-cervical lordosis (CL), anterolisthesis, local kyphosis, the longitudinal distance index, and range of motion were proposed to have relationships with clinical outcomes. The relationship between loss of cervical lordosis (LCL) and T1s has been widely studied, but controversy remains. Extension function, the ratio of CL to T1s (CL/T1s), and Sharma classification were recently proposed as LCL predictors. In predicting postoperative kyphosis, T1s cannot predict postoperative kyphosis, but a low CL/T1s ratio was associated with postoperative kyphosis.
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Affiliation(s)
- Su Hun Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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Shao T, Gu J, Zhu Y, Tang W, Li Q, Lu J, Hu Y, Yu Z, Shen H. Modified axial computed tomography classification of cervical ossification of the posterior longitudinal ligament: selecting the optimal operating procedure and enhancing the accuracy of prognosis. Quant Imaging Med Surg 2021; 11:1888-1898. [PMID: 33936972 DOI: 10.21037/qims-20-862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cervical ossification of the posterior longitudinal ligament (OPLL) causes spinal cord compression, which can lead to myelopathy or radiculopathy. Non-surgical treatments have little effect on this condition. Current OPLL classification systems offer little guidance on the selection of an appropriate operating procedure. In this study, we developed a modified axial computed tomography classification (MACTC) scheme. We then examined the usefulness of the MACTC scheme and two other existing classification schemes in guiding OPLL operation choice. Methods Following screening in which a defined exclusion criteria was used, a total of 91 patients with OPLL participated in the study. Patients' follow-up data for at least 2 years were obtained. The recovery rate of the Japanese Orthopaedic Association (JOA) scores was compared to two other classification schemes. Results According to the MACTC, central-sharp-type OPLL had a lower recovery rate of the JOA score than that of central-gentle-type OPLL (36.05±32.38 vs. 83.90±23.52, P≤0.05). The recovery rate of the JOA scores in the ipsilateral open-door OPLL group was significantly lower than that in the contralateral group of the lateral-steep type (36.67±41.5 vs. 88.89±17.21, P=0.04), but not of that in the lateral-gentle type. There was no significant difference in the recovery rates of the JOA scores between groups when using either existing classification scheme (P>0.05). Conclusions The MACTC scheme can assist surgeons to choose the most appropriate operating procedure, and provide an accurate prognosis. If operations on central-sharp-type OPLL are not performed using both the posterior and anterior approaches, prognosis will be poor. The contralateral side should be the first choice for door opening in laminoplasty, especially for patients with lateral-steep-type OPLL. Severe OPLL may not be an absolute contraindication for the posterior approach.
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Affiliation(s)
- Tuo Shao
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiao Gu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yigeng Zhu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weilong Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qingsong Li
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Juncheng Lu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuhang Hu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhange Yu
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongtao Shen
- Department of Spinal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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The Impact of Anterior Spondylolisthesis and Kyphotic Alignment on Dynamic Changes in Spinal Cord Compression and Neurological Status in Cervical Spondylotic Myelopathy: A Radiological Analysis Involving Kinematic CT Myelography and Multimodal Spinal Cord Evoked Potentials. Spine (Phila Pa 1976) 2021; 46:72-79. [PMID: 33038192 DOI: 10.1097/brs.0000000000003735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study of prospectively collected data. OBJECTIVE This study aimed to examine how radiological parameters affect dynamic changes in the cross-sectional area of the spinal cord (CSA) in cervical spondylotic myelopathy (CSM) patients and how they correlate with the severity of myelopathy, by evaluating multi-modal spinal cord evoked potentials (SCEPs). SUMMARY OF BACKGROUND DATA Appropriate assessments of dynamic factors should reveal hidden spinal cord compression and provide useful information for choosing surgical procedures. METHODS Seventy-nine CSM patients were enrolled. They were examined with kinematic CT myelography (CTM), and the spinal levels responsible for their CSM were determined via SCEP examinations. The C2-7 angle, C2-7 range of motion, and percentage of slip were measured on the midsagittal view during flexion and extension, and the CSA was measured on the axial view in each neck position using kinematic CTM. The patients who exhibited the smallest CSA values during extension and flexion were classified into Groups E and F, respectively. RESULTS Fifty-two (65.8%) and 27 (34.2%) cases were included in Groups E and F, respectively. The preoperative JOA score did not differ significantly between the groups; however, the preoperative lower-limb JOA score of Group F was significantly lower than that of Group E (2.24 ± 0.82 vs. 2.83 ± 1.09, P = 0.016). In the multiple logistic regression analysis, a small C2-7 angle during extension (β = 5°, odds ratio: 0.69, 95% confidence interval [CI]: 0.54-0.90) and the slip percentage during flexion (β = 5%, odds ratio: 1.42, 95% CI: 1.09-1.85) were identified as significant predictors of belonging to Group F. CONCLUSION Exhibiting more severe spinal cord compression during neck flexion was associated with a small C2-7 angle and anterior spondylolisthesis. The neurological status of the patients in Group F was characterized by severe lower limb dysfunction because of a disturbed blood supply to the anterior column.Level of Evidence: 4.
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The radiological characteristics associated with the development of myelopathy due to ossification of the posterior longitudinal ligaments at each responsible level based on spinal cord evoked potentials. Clin Neurol Neurosurg 2020; 194:105814. [PMID: 32298951 DOI: 10.1016/j.clineuro.2020.105814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/09/2020] [Accepted: 03/20/2020] [Indexed: 11/22/2022]
Abstract
STUDY DESIGN This was a retrospective study of prospectively collected data. OBJECTIVE This study aimed to characterize the factors associated with the development of myelopathy at each cervical level based on spinal cord evoked potentials (SCEPs) and radiological parameters in patients with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Static factors, dynamic factors, and combinations of these factors are associated with the development of OPLL-related myelopathy. PATIENTS AND METHODS Fifty patients with OPLL were enrolled in this study. They underwent kinematic computed tomography myelography (CTM), MRI, and X-ray examinations, and the levels responsible for their myelopathy were determined by intraoperatively assessing SCEPs. C2-7 lordosis, C2-7 range of motion (ROM), and segmental ROM were assessed on the midsagittal view during flexion and extension and in the neutral position using the Cobb method, and the cross-sectional area of the spinal cord (CSA) was measured on the axial view in each neck position using kinematic CTM. The cervical levels were classified into responsible (Group R) and non-responsible (Group N) levels. RESULTS The responsible level was C3-4, C4-5, C5-6, and C6-7 in 18, 23, 18, and 4 patients, respectively. In the multivariate analysis, the CSA was significantly smaller in Group R than in Group N at all responsible levels, but the dynamic change in the CSA was only associated with myelopathy at the C3-4 and C4-5 levels. CONCLUSION Myelopathy at the C3-4 level was more strongly associated with dynamic factors and a shorter disease duration, than myelopathy at the C5-6 level. This study provides useful information for assessing the pathophysiology of OPLL-related cervical myelopathy and managing the condition.
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Bakhsh W, Saleh A, Yokogawa N, Gruber J, Rubery PT, Mesfin A. Cervical Ossification of the Posterior Longitudinal Ligament: A Computed Tomography-Based Epidemiological Study of 2917 Patients. Global Spine J 2019; 9:820-825. [PMID: 31819847 PMCID: PMC6882099 DOI: 10.1177/2192568219833658] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To identify prevalence of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine in a large sample, to characterize spinal involvement, and to identify associations with patient characteristics. METHODS Computed tomography (CT) scans of all patients receiving cervical spine CT imaging in a level-1 emergency department from January 1, 2014 to December 31, 2014 were reviewed. Diagnosis and classification of OPLL was performed, and data for associated patients was obtained (age, sex, race, ethnicity, body mass index, diabetes). US Census data was referenced for the sample population. Statistical analysis included t test and chi-square testing, with significance cutoff P < .05. RESULTS There were no significant differences between the sample and population data. Of 2917 patients reviewed, 74 exhibited OPLL (2.5%). Age distribution between OPLL and non-OPLL cohorts was significantly different (P < .01), with highest prevalence of OPLL between ages 40 to 49 and 50 to 59 years. Comorbid diabetes also differed between groups (27% OPLL, 13% non-OPLL, P < .01). There was no difference in distribution of sex, race, or ethnicity. For OPLL, segmental type is most common (67.6%), involving on average 3.4 levels. OPLL involvement begins at any level, but ends most commonly at C6 (40.5%) or C7 (36.5%). Among OPLL patients, 18 (24.3%) demonstrated concurrent ponticulus posticus. CONCLUSIONS This review of 2917 patients reaffirms previous data, with OPLL prevalence of 2.5%. In asymptomatic patients, incidental diagnosis is frequently seen as early as ages 40 to 49 years. OPLL is better characterized with a significant association with diabetes, segmental type being the most common, and the caudal extent typically involving C6-7 (77%).
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Affiliation(s)
- Wajeeh Bakhsh
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Ahmed Saleh
- Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Jillian Gruber
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Paul T. Rubery
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Addisu Mesfin
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA,Addisu Mesfin, Department of Orthopaedic Surgery & Neurosurgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA.
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Shimokawa N, Sato H, Matsumoto H, Takami T. Review of Radiological Parameters, Imaging Characteristics, and Their Effect on Optimal Treatment Approaches and Surgical Outcomes for Cervical Ossification of the Posterior Longitudinal Ligament. Neurospine 2019; 16:506-516. [PMID: 31607082 PMCID: PMC6790724 DOI: 10.14245/ns.1938268.134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Determining the optimal surgical method for cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. The surgical indication should be made based on not only radiological findings, but also the patient’s age, preoperative neurological findings, social background, activities of daily life, and the presence or absence of comorbid diseases. Anterior resection for OPLL with or without wide corpectomy and fusion, posterior decompression with or without relatively long fusion, or anterior and posterior combined surgery may be considered. When evaluating the clinical condition of patients with cervical OPLL before surgery, various radiological parameters should be carefully considered, including the number of spinal segments involved, the cervical alignment or tilt angle, the relationship between OPLL and the C2–7 line (termed the “K-line”), the occupying ratio of OPLL, and the involvement of dural ossification. The objective of this article is to review the radiological parameters in current use for deciding upon the optimal surgical strategy and for predicting surgical outcomes, focusing on cervical OPLL.
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Affiliation(s)
| | - Hidetoshi Sato
- Department of Neurosurgery, Tsukazaki Hospital, Hyogo, Japan
| | | | - Toshihiro Takami
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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12
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Tetreault L, Nakashima H, Kato S, Kryshtalskyj M, Nagoshi N, Nouri A, Singh A, Fehlings MG. A Systematic Review of Classification Systems for Cervical Ossification of the Posterior Longitudinal Ligament. Global Spine J 2019; 9:85-103. [PMID: 30775213 PMCID: PMC6362555 DOI: 10.1177/2192568217720421] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
DESIGN Systematic review. OBJECTIVE To conduct a systematic review to (1) summarize various classification systems used to describe cervical ossification of the posterior longitudinal ligament (OPLL) and (2) evaluate the diagnostic accuracy of various imaging modalities and the reliability of these classification systems. METHODS A search was performed to identify studies that used a classification system to categorize patients with OPLL. Furthermore, studies were included if they reported the diagnostic accuracy of various imaging modalities or the reliability of a classification system. RESULTS A total of 167 studies were deemed relevant. Five classification systems were developed based on X-ray: the 9-classification system (0.60%); continuous, segmental, mixed, localized or focal, circumscribed and others (92.81%); hook, staple, bridge, and total types (2.40%); distribution of OPLL (2.40%); and K-line classification (4.19%). Six methods were based on computed tomography scans: free-type, contiguous-type, and broken sign (0.60%); hill-, plateau-, square-, mushroom-, irregular-, or round-shaped (5.99%); rectangular, oval, triangular, or pedunculate (1.20%); centralized or laterally deviated (1.80%); plank-, spindle-, or rod-shaped (0.60%); and rule of nine (0.60%). Classification systems based on 3-dimensional computed tomography were bridging and nonbridging (1.20%) and flat, irregular, and localized (0.60%). A single classification system was based on magnetic resonance imaging: triangular, teardrop, or boomerang. Finally, a variation of methods was used to classify OPLL associated with the dura mater (4.19%). CONCLUSIONS The most common method of classification was that proposed by the Japanese Ministry of Health, Labour and Welfare. Other important methods include K-line (+/-), signs of dural ossification, and patterns of distribution.
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Affiliation(s)
- Lindsay Tetreault
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada,These authors contributed equally to this work
| | - Hiroaki Nakashima
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan,These authors contributed equally to this work
| | - So Kato
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Michael Kryshtalskyj
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nagoshi Nagoshi
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Aria Nouri
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Anoushka Singh
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8.
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13
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Li S, Zhang P, Gao X, Miao D, Gao Y, Shen Y. Potential risk factors for poor outcome after anterior surgery for patients with cervical ossification of the posterior longitudinal ligament. Ther Clin Risk Manag 2018; 14:341-347. [PMID: 29503553 PMCID: PMC5824755 DOI: 10.2147/tcrm.s152416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Our purpose here was to identify risk factors of poor outcome after anterior operation in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods This study retrospectively reviewed 98 patients who underwent anterior surgery for improving neurological symptoms. The Japanese Orthopedic Association (JOA) recovery rate <50% was defined as poor surgical outcome. We investigated the relationship between various predictors and outcome by logistic regression analysis and receiver operating characteristic curves. To explore the cause of cerebrospinal fluid (CSF) leakage, we used the Mann–Whitney U-test, χ2 test, or independent t-test. Results Multivariate logistic regression analysis showed that age (odds ratio [OR] =1.1, 95% confidence interval [CI] =1.03–1.18, P=0.005), occupying ratio of OPLL (OR =1.08, 95% CI =1.03–1.12, P=0.001), and residual ratio of OPLL (OR =1.07, 95% CI =1.02–1.13, P=0.008) were independently associated with poor outcome. The cutoffs of the above risk factors were set at 63.5 years, 39.65%, and 25.165%, respectively. Predictors for CSF leakage were occupying ratio of OPLL, the K-line, and shape of the ossified lesion (P<0.001, P=0.019, and P=0.003). Conclusion These findings suggest that advanced age, high occupying ratio of OPLL, and high residual ratio of OPLL were risk factors for postoperative poor outcome in patients with OPLL. In addition, the high occupying ratio of OPLL, the K-line (−), and hill-shape ossification were potential causes of CSF leakage.
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Affiliation(s)
- Shaoqing Li
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Peng Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Xianda Gao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Dechao Miao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yanlong Gao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yong Shen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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Kanbara S, Imagama S, Ito K, Ito K, Ishiguro N, Kato F. A retrospective imaging study of surgical outcomes and range of motion in patients with cervical ossification of the posterior longitudinal ligament. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1416-1422. [PMID: 28766019 DOI: 10.1007/s00586-017-5246-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 07/02/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The K line was introduced in a previous study, but did not include the cervical range of motion (ROM) as a parameter for evaluating surgical outcomes for patients with cervical ossification of the posterior longitudinal ligament (OPLL), and few reports have used both the K line and X-ray evaluations of the cervical ROM to describe the surgical outcomes in such patients. METHODS Double-door C2-C7 or C3-C7 laminoplasty was performed in 100 patients with cervical OPLL who were classified according to the K line [86 patients, K line (+) and 14 patients, K line (-)]. Preoperative and 1-year postoperative Japanese Orthopedic Association (JOA) scores were used to evaluate recovery rates. Preoperative and postoperative C2-C7 lordotic angles were measured using the Cobb method. In addition, preoperative and postoperative sagittal alignments in flexion and extension were studied, and the flexion values were calculated by subtracting the preoperative and postoperative flexion ROM from extension ROM. RESULTS The mean JOA scores recovery rate were 57.3% in the K line (+) and 37.7% in the K line (-) groups (p < 0.05), and the respective corresponding mean postoperative C2-C7 lordotic angles were 9.1° and -3.4° (p < 0.001). In the K line (+) group, the JOA score recovery rate for a postoperative flexion value >0 was significantly lower than that for a postoperative flexion value ≤0 (p < 0.01), and the mean JOA score recovery rate worsened with an increased signal intensity on 1-year postoperative magnetic resonance imaging. CONCLUSIONS K line (+) patients exhibited sufficient neurological improvement after laminoplasty. However, even patients in this group had a low JOA score recovery rate if the postoperative flexion value was >0 and the 1-year postoperative increased signal intensity grade was 2 or 3.
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Affiliation(s)
- Shunsuke Kanbara
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Hospital, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Hospital, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan.
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Hospital, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Hospital, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
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Khuyagbaatar B, Kim K, Park WM, Lee S, Kim YH. Increased stress and strain on the spinal cord due to ossification of the posterior longitudinal ligament in the cervical spine under flexion after laminectomy. Proc Inst Mech Eng H 2017; 231:898-906. [PMID: 28660796 DOI: 10.1177/0954411917718222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myelopathy in the cervical spine due to cervical ossification of the posterior longitudinal ligament could be induced by static compression and/or dynamic factors. It has been suggested that dynamic factors need to be considered when planning and performing the decompression surgery on patients with the ossification of the posterior longitudinal ligament. A finite element model of the C2-C7 cervical spine in the neutral position was developed and used to generate flexion and extension of the cervical spine. The segmental ossification of the posterior longitudinal ligament on the C5 was assumed, and laminectomy was performed on C4-C6 according to a conventional surgical technique. For various occupying ratios of the ossified ligament between 20% and 60%, von-Mises stresses, maximum principal strains in the spinal cord, and cross-sectional area of the cord were investigated in the pre-operative and laminectomy models under flexion, neutral position, and extension. The results were consistent with previous experimental and computational studies in terms of stress, strain, and cross-sectional area. Flexion leads to higher stresses and strains in the cord than the neutral position and extension, even after decompression surgery. These higher stresses and strains might be generated by residual compression occurring at the segment with the ossification of the posterior longitudinal ligament. This study provides fundamental information under different neck positions regarding biomechanical characteristics of the spinal cord in cervical ossification of the posterior longitudinal ligament.
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Affiliation(s)
| | - Kyungsoo Kim
- 2 Department of Applied Mathematics, Kyung Hee University, Yongin, Korea
| | - Won Man Park
- 1 Department of Mechanical Engineering, Kyung Hee University, Yongin, Korea
| | - SuKyoung Lee
- 3 Department of Computer Science, Yonsei University, Seoul, Korea
| | - Yoon Hyuk Kim
- 1 Department of Mechanical Engineering, Kyung Hee University, Yongin, Korea
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MRI Signal Intensity Classification in Cervical Ossification of the Posterior Longitudinal Ligament: Predictor of Surgical Outcomes. Spine (Phila Pa 1976) 2017; 42:E98-E103. [PMID: 27244260 DOI: 10.1097/brs.0000000000001717] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To investigate whether classification of increased signal intensity (ISI) on magnetic resonance imaging (MRI) of spinal cord in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL) reflects severity of myelopathy and surgical outcome. SUMMARY OF BACKGROUND DATA The relationship between classification of ISI on C-OPLL and severity is unknown. METHODS The 119 consecutive patients (91 men, 28 women) with C-OPLL who underwent surgery were enrolled. T2-weighted MRI was performed before surgery and ISI was classified into three groups as follows, Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). The severity of myelopathy and surgical outcome were evaluated by the Japanese Orthopedic Association score. To determine factors that influence ISI, the change of the spinal cord cross-sectional area (SCA) during flexion and extension was calculated by computed tomography after myelography. RESULTS The preoperative MRI showed 55 patients in Grade 0, 46 patients in Grade 1, and 18 patients in Grade 2. The preoperative Japanese Orthopedic Association score (Grade 0, 11.2; Grade 1, 10.3; Grade 2, 9.6 points) and surgical outcome got worsened with increasing ISI grade. The patients in Grade 2 had a longer duration of disease, while those in Grade 1 and Grade 2 had a larger change of SCA during flexion and extension (Grade 0, 4.8 mm; Grade 1, 7.3 mm; Grade 2, 7.8 mm). However age, alignment of the cervical spine, range of motion, and occupying ratio of the ossification were not different in the three grades. CONCLUSION Grade of ISI correlated with preoperative severity of myelopathy and surgical outcome in patients with C-OPLL. Increased signal intensity of the spinal cord on MRI was associated with a larger change in SCA and longer duration of disease. LEVEL OF EVIDENCE 3.
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Tumor Occupation in the Spinal Canal and Clinical Symptoms of Cauda Equina Schwannoma: An Analysis of 22 Cases. Asian Spine J 2016; 10:1079-1084. [PMID: 27994784 PMCID: PMC5164998 DOI: 10.4184/asj.2016.10.6.1079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective, radiological study. PURPOSE To determine the relationship between clinical symptoms and the extent of tumor occupation of the spinal canal by cauda equina schwannoma. OVERVIEW OF LITERATURE Little is known about the relationship between the size of tumors of the cauda equina and the manifestation of clinical symptoms. We analyzed this relationship by estimating the percentage of tumor occupation (PTO) in the spinal canal in cauda equina schwannomas and by correlating this parameter with the presence and severity of clinical symptoms. METHODS Twenty-two patients (9 men and 13 women; age, 19-79 years; mean age, 55.3 years) who were radiologically diagnosed with schwannomas of the cauda equina between April 2004 and July 2014 were retrospectively analyzed. PTO was measured in axial and sagittal magnetic resonance imaging slices in which the cross-sectional area of the tumor was the largest. Data regarding clinical symptoms and results of physical examinations were collected from patient medical records. PTO differences between symptom-positive and -negative groups were analyzed for each variable. RESULTS In the 4 cases in which tumor presence was not related to clinical symptoms, PTO was 5%-10% (mean, 9%) in axial slices and 23%-31% (mean, 30%) in sagittal slices. In the 18 cases in which symptoms were associated with the tumor, PTO was 11%-86% (mean, 50%) in axial slices and 43%-88% (mean, 71%) in sagittal slices. PTO in axial slices was significantly higher in the presence of Déjèrine symptoms and/or muscle weakness, a positive straight leg raise test, and a positive Kemp sign. CONCLUSIONS PTO >20% in axial slices and >40% in sagittal slices can be an indication of symptomatic cauda equina schwannoma.
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Abiola R, Rubery P, Mesfin A. Ossification of the Posterior Longitudinal Ligament: Etiology, Diagnosis, and Outcomes of Nonoperative and Operative Management. Global Spine J 2016; 6:195-204. [PMID: 26933622 PMCID: PMC4771496 DOI: 10.1055/s-0035-1556580] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/28/2015] [Indexed: 01/04/2023] Open
Abstract
Study Design Narrative review. Objective To provide an overview on the diagnosis, natural history, and nonoperative and operative management of ossification of the posterior longitudinal ligament (OPLL). OPLL is a multifactorial condition caused by ectopic hyperostosis and calcification of the posterior longitudinal ligament. Familial inheritance and genetic factors have been implicated in the etiology of OPLL. The cervical spine is most commonly affected followed by the thoracic spine. The clinical manifestations range from asymptomatic to myelopathy or myeloradiculopathy. Methods Using PubMed, studies published prior to October 2014 with the keywords "OPLL, etiology"; "OPLL, genetics"; "OPLL, spinal cord injury"; "OPLL, natural history"; "OPLL, non-surgical management"; OPLL, surgical management"; "OPLL, surgical complications" were evaluated. Results The review addresses the etiology, epidemiology, classification, clinical presentation, imaging findings, and nonoperative and operative management of OPLL. Complications associated with surgical management of OPLL are also discussed. Conclusions OPLL commonly presents with myelopathy and radiculopathy. Spine providers should consider OPLL in their differential diagnosis and when reviewing images. If surgical intervention is pursued, imaging-based measurements and findings can help in choosing an anterior versus posterior surgical approach.
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Affiliation(s)
- Rasheed Abiola
- Department of Orthopaedic Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin, United States
| | - Paul Rubery
- Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, New York, United States
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, New York, United States,Address for correspondence Addisu Mesfin, MD Department of Orthopaedic Surgery and OncologyUniversity of Rochester School of Medicine and Dentistry601 Elmwood Avenue, Box 665, Rochester, NY 14642United States
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