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Wu P, Guan Y, Wang M, Zhang L, Zhao D, Cui X, Liu J, Qiu B, Tao J, Wang Y, Ou S. Classification and microsurgical treatment of foramen magnum meningioma. Chin Neurosurg J 2023; 9:3. [PMID: 36691052 PMCID: PMC9872311 DOI: 10.1186/s41016-022-00315-y] [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: 03/04/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To investigate the classification and microsurgical treatment of foramen magnum meningioma (FMM). METHODS We retrospectively analyzed 76 patients with FMM and classified them into two classifications, classification ABS according to the relationship between the FMM and the brainstem and classification SIM according to the relationship between the FMM and the vertebral artery (VA). All patients underwent either the far lateral approach (54 cases) or the suboccipital midline approach (22 cases). RESULTS Of the 76 cases, 47 cases were located ahead of the brainstem (A), 16 cases at the back of the brainstem (B), and 13 cases were located laterally to the brainstem (S). There were 15 cases located superior to the VA (S), 49 cases were inferior (I), and 12 cases were mixed type (M). Among 76 cases, 71 cases were resected with Simpson grade 2 (93.42%), 3 with Simpson grade 3 (3.95%), and 2 with Simpson grade 4 (2.63%). We summarized four anatomical triangles: triangles SOT, VOT, JVV, and TVV. The mean postoperative Karnofsky performance score was improved in all patients (p < 0.05). However, several complications occurred, including hoarseness and CSF leak. CONCLUSION ABS and SIM classifications are objective indices for choosing the surgical approach and predicting the difficulty of FMMs, and it is of great importance to master the content, position relationship with the tumor, and variable anatomical structures in the four "triangles" for the success of the operation.
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Affiliation(s)
- Pengfei Wu
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Yanlei Guan
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Minghao Wang
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Luyang Zhang
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Dan Zhao
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Xiao Cui
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Jiyuan Liu
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Bo Qiu
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Jun Tao
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Yunjie Wang
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
| | - Shaowu Ou
- grid.412449.e0000 0000 9678 1884Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001 Liaoning China
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Hartmann S, Tschugg A, Wipplinger C, Thomé C. Analysis of the Literature on Cervical Spine Fractures in Ankylosing Spinal Disorders. Global Spine J 2017; 7:469-481. [PMID: 28811992 PMCID: PMC5544161 DOI: 10.1177/2192568217700108] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Narrative literature review. OBJECTIVE The numbers of low-energy cervical fractures seen in patients suffering from ankylosing spondylitis (also known as Bechterew disease) or diffuse idiopathic skeletal hyperostosis (also known as Forestier disease) have greatly increased over recent decades. These fractures tend to be particularly overlooked, leading to delayed diagnosis and secondary neurological deterioration. The aim of the present evaluation was to summarize current knowledge on cervical fractures in patients with ankylosing spinal disorders (ASDs). METHODS The literature was analyzed through an extensive PubMed search focusing on cervical fractures, especially with delayed diagnosis. RESULTS In ASDs, it was mainly the cervical spine that was found to be affected by fractures. Fifty percent of ASD patients had neurological deficits at admission, with a high probability of secondary deterioration due to an initially missed diagnosis. Multislice high-resolution imaging techniques should be the radiological standard of care if a vertebral fracture is suspected. Nevertheless, many of these spinal fractures are overlooked, leading to feared secondary deterioration of existing unstable fractures. Long posterior instrumentations were found to be the treatment of choice, followed by anterior and combined anterior-posterior instrumentations. CONCLUSIONS Delayed diagnosis of cervical fractures in ASDs contributes to initially misinterpreted clinical symptoms, inadequate imaging techniques, and a lack of knowledge about this disease entity due to its peculiarities. Thorough assessment of the patients' neurological morbidity at admission might reduce the occurrence of the associated fractures. The biomechanical behavior of ASD fractures is completely different from that of non-ASD fractures, so that the treatment strategy for these patients should be at least surgical, in combination with long dorsal instrumentations or combined anterior-posterior approaches.
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Affiliation(s)
- Sebastian Hartmann
- Medical University of Innsbruck, Innsbruck, Austria,Sebastian Hartmann, Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Anja Tschugg
- Medical University of Innsbruck, Innsbruck, Austria
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Vaishya R, Vijay V, Nwagbara IC, Agarwal AK. Diffuse idiopathic skeletal hyperostosis (DISH) - A common but less known cause of back pain. J Clin Orthop Trauma 2017; 8:191-196. [PMID: 28721001 PMCID: PMC5498746 DOI: 10.1016/j.jcot.2016.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/12/2016] [Indexed: 12/29/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic non-inflammatory disease of an unknown aetiology. It is characterized by ossification of the enthesis and may significantly affect the quality of life of the affected individuals. Despite the fact that this disease was first described more than 60 years ago and is a relatively common condition in the society, its awareness among clinician is still limited. An awareness of this entity and its mimicking conditions is essential so as to reach to an early diagnosis and avoid unnecessary investigations and treatment.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India,Corresponding author.
| | - Vipul Vijay
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India
| | | | - Amit K. Agarwal
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi 110067, India
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Decker SD, Volk HA. Dorsal vertebral column abnormalities in dogs with disseminated idiopathic skeletal hyperostosis (DISH). Vet Rec 2014; 174:632. [PMID: 24828088 DOI: 10.1136/vr.102492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Although disseminated idiopathic skeletal hyperostosis (DISH) most often affects the ventral aspect of the vertebral column, this study evaluated the occurrence, nature and clinical relevance of dorsal vertebral column abnormalities in 10 dogs with DISH for which CT or MRI and a complete neurological examination were available. Dorsal vertebral column abnormalities were present in eight dogs and included articular process hypertrophy (n=7 dogs), periarticular new bone formation (n=1), pseudoarthrosis between spinous processes (n=4) and thickening of the dorsal lamina (n=4). These dorsal vertebral abnormalities caused clinically relevant vertebral canal stenosis in six dogs and were the only cause of clinical signs in four of these dogs. Although the lumbosacral joint was not affected by DISH, these six dogs demonstrated lumbosacral vertebral canal stenosis and clinical signs of cauda equina compression, which included paraparesis (n=5 dogs), lumbosacral pain (n=4), urinary incontinence (n=4), faecal incontinence (n=1) and urinary and faecal incontinence (n=1). There is a possible association between DISH and hypertrophy of dorsal vertebral structures, potentially resulting in vertebral canal stenosis. Although these changes occurred at segments fused by DISH, they predominantly affected adjacent non-affected segments.
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Affiliation(s)
- S De Decker
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire AL97TA, UK
| | - H A Volk
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire AL97TA, UK
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Koizumi S, Yamaguchi-Okada M, Namba H. Myelopathy due to multilevel cervical canal stenosis with Forestier disease: case report. Neurol Med Chir (Tokyo) 2013; 50:942-5. [PMID: 21030813 DOI: 10.2176/nmc.50.942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 56-year-old woman presented with multilevel myelopathy associated with Forestier disease (FD). The patient was hospitalized for dysphagia, bilateral shoulder pain, and progressive gait disturbance. The diagnosis was confirmed by radiography and magnetic resonance imaging which demonstrated coalescent anterior osteophyte formation extending from C2 to C7 with atlanto-axial dislocation and persistence of mobility at C3-4, and a hyperintense area in the spinal cord at the C1 and C3-4 levels on T(2)-weighted images. Dynamic radiography showed no instability at the C1 and C3-4 levels. Decompressive laminectomy of the atlas, dome-like laminectomy, and facet fusion at C3-4 were performed, resulting in symptomatic improvement. Myelopathy is very rare in patients with FD and is due to mechanical stress at the level where mobility persists. Strategic intervention should be considered based on evaluation of mobile levels and stenotic lesions.
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Affiliation(s)
- Shinichiro Koizumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hmamatsu, Shizouka, Japan
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Factors influencing on retro-odontoid soft-tissue thickness: analysis by magnetic resonance imaging. Spine (Phila Pa 1976) 2013; 38:401-6. [PMID: 23448899 DOI: 10.1097/brs.0b013e3182715c07] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective, consecutive case series. OBJECTIVE To analyze the relationship between retro-odontoid soft-tissue thickness and patients' age, sex, and degenerative changes of cervical spine and to investigate the effect these factors have on retro-odontoid soft-tissue thickness. SUMMARY OF BACKGROUND DATA Thickening of the soft tissue posterior to the odontoid process can form a retro-odontoid pseudotumor causing symptoms of spinal cord compression. Rheumatoid arthritis and long-term dialysis have been reported as possible causes for this. However, there have been reports of retro-odontoid pseudotumors without coexisting diseases. METHODS Findings from a total of 503 cases of cervical spine magnetic resonance images were reviewed, and retro-odontoid soft-tissue thickness was measured. The values were matched for age, sex, presence of degenerative changes, rheumatoid arthritis, and dialysis and were analyzed for significance. RESULTS Retro-odontoid soft tissue thickened with age, and this was also seen in male patients and patients with degenerative changes. Significant increase in thickness was also observed in patients undergoing dialysis and further increased with prolonged dialysis. There was no significant association with presence of rheumatoid arthritis. CONCLUSION There is association between age, sex, degenerative cervical spine changes, and dialysis with retro-odontoid soft-tissue thickness. With dialysis, retro-odontoid soft-tissue thickness increases with increasing duration. Thus, reviewing magnetic resonance image from daily practice indicates that cervical spine degeneration is associated with the development of retro-odontoid pseudotumors.
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Dysphagia due to Diffuse Idiopathic Skeletal Hyperostosis. Case Rep Otolaryngol 2012; 2012:123825. [PMID: 22953098 PMCID: PMC3420730 DOI: 10.1155/2012/123825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 02/02/2012] [Indexed: 12/02/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is usually asymptomatic. However, rarely, it causes dysphagia, hoarseness, dyspnea, snoring, stridor, and laryngeal edema. Herein, we present a patient with DISH causing dysphagia. A 70-year-old man presented with a 4-month history of sore throat, dysphagia, and foreign body sensation. Flexible laryngoscopy revealed a leftward-protruding posterior wall in the hypopharynx. Computed tomography and magnetic resonance imaging revealed a bony mass pushing, anteriorly, on the posterior hypopharyngeal wall. Ossification included an osseous bridge involving 5 contiguous vertebral bodies. Dysphagia due to DISH was diagnosed. His symptoms were relieved by conservative therapy using anti-inflammatory drugs. However, if conservative therapy fails and symptoms are severe, surgical treatments must be considered.
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Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review. 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 2010; 20 Suppl 2:S195-201. [DOI: 10.1007/s00586-010-1538-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 06/26/2010] [Accepted: 07/18/2010] [Indexed: 10/19/2022]
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Kawabori M, Hida K, Akino M, Yano S, Saito H, Iwasaki Y. Cervical myelopathy by C1 posterior tubercle impingement in a patient with DISH. Spine (Phila Pa 1976) 2009; 34:E709-11. [PMID: 19730204 DOI: 10.1097/brs.0b013e3181aa26a4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A unique case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) associated with C1 posterior tubercle impingement resulting in spinal canal stenosis and cervical myelopathy. OBJECTIVE To describe an uncommon mechanism of spinal cord compression in patient with DISH. SUMMARY OF BACKGROUND DATA The neurologic deficits due to cervical DISH are relatively rare and a few cases of cervical spinal cord compression due to atlantoaxial subluxation, odontoid fracture, pseudotumor, ligamentous hypertrophy, and basilar impression have been reported. To the best of our knowledge, there has been no other report of a patient with DISH causing C1 posterior tubercle impingement and cervical myelopathy. METHODS A 75-year-old Japanese man, first diagnosed as hyperostosis of anterior and posterior longitudinal ligament 25 years ago, presented with gradual progression of numbness in both lower extremities, disturbed precise hand motion and urinary function. DISH, OPLL, and C1 posterior tubercle impingement was diagnosed by radiograph, CT, and MRI. Hyperintense signal in the C1 spinal cord on T2 weighted sequence was observed. RESULT Laminectomy from C1-C3 was performed. Myelocompression and myelopathy improved after the surgical intervention. Multilevel fusion of the subaxial cervical spine and increase of the mechanical stress on the craniocervical segment may leads to partial damage of the ligaments and resulted in C1 posterior arch impingement. CONCLUSION This is the first report of unique C1 posterior tubercle impingement and myelopathy caused by DISH. We should keep it in mind that DISH can cause serious problems in the upper cervical spine even after 25 years of interval.
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Affiliation(s)
- Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. 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 2008; 18:145-56. [PMID: 18791749 DOI: 10.1007/s00586-008-0764-0] [Citation(s) in RCA: 393] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 06/20/2008] [Accepted: 08/14/2008] [Indexed: 12/11/2022]
Abstract
The ankylosed spine is prone to fracture after minor trauma due to its changed biomechanical properties. Although many case reports and small series have been published on patients with ankylosing spondylitis (AS) suffering spine fractures, solid data on clinical outcome are rare. In advanced diffuse idiopathic skeletal hyperostosis (DISH), ossification of spinal ligaments also leads to ankylosis. The prevalence of AS is stable, but since DISH may become more widespread due to its association with age, obesity and type 2 diabetes mellitus, a systematic review of the literature was conducted to increase the current knowledge on treatment, neurological status and complications of patients with preexisting ankylosed spines sustaining spinal trauma. A literature search was performed to obtain all relevant articles concerning the outcome of patients with AS or DISH admitted with spinal fractures. Predefined parameters were extracted from the papers and pooled to study the effect of treatment on neurological status and complications. Ninety-three articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. This review suggests that the clinical outcome of patients with fractures in previously ankylosed spines, due to AS or DISH, is considerably worse compared to the general trauma population. Considering the potential increase in prevalence of DISH cases, this condition may render a new challenge for physicians treating spinal injuries.
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Storch MJ, Hubbe U, Glocker FX. Cervical myelopathy caused by soft-tissue mass in diffuse idiopathic skeletal hyperostosis. 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 2007; 17 Suppl 2:S243-7. [PMID: 17922151 DOI: 10.1007/s00586-007-0508-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 07/11/2007] [Accepted: 09/17/2007] [Indexed: 11/25/2022]
Abstract
A rare case of cervical spinal cord compression in diffuse idiopathic skeletal hyperostosis (DISH or Forestier's Disease) caused by a craniocervical mass of soft-tissue is reported. The objective is to describe an uncommon mechanism of spinal cord compression in DISH. Three weeks after a cardiac infarction a 69-year-old man slowly developed spastic tetraparesis. Magnetic resonance tomography showed a craniocervical tumor compressing the spinal cord and a massive DISH of the cervical spine. An extended mass of yellowish amorphous material was removed from between the dura, the posterior odontoid process and the posterior aspect of vertebral body C2 reaching to the upper part of C3.The histologic appearance indicated connective tissue and cell-degenerated cartilaginous tissue. There was no inflammatory component and no evidence of neoplasia. No ossification of the posterior longitudinal ligament (OPLL) was found. After removal and craniocervical stabilization the patient's neurologic function improved remarkably. The increase of mechanical stress on the atlantoaxial segment and enhanced proliferation reaction of the connective tissue in DISH are suggested as the underlying pathomechanisms in the formation of this soft-tissue mass.
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Affiliation(s)
- Max-Jürgen Storch
- Seidel-Klinik, Center for Rheumatology, Spinal Disorders and Neuromuscular Diseases, Hebelweg 4, 79415, Bad Bellingen, Germany.
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