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Symptomatic myelopathy caused by ossification of the yellow ligament.

Park DA, Kim SW, Lee SM, Kim CG, Jang SJ, Ju CI - Korean J Spine (2012)

Bottom Line: Among them, 5 patients presented with gait disturbance due to paraparesis and two patients had sphincter dysfunction.The mean postoperative Japanese orthopaedics association (JOA) score was 7.9 when compared with 4.9 in preoperative assessment and the mean recovery rate was 65%.Dural tear was noticed in four patients, so dural repair was performed, but there were no neurological deficits related to neural injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Republic of Korea.

ABSTRACT

Objective: This study was performed to describe the clinical presentation, surgical outcome in patients with symptomatic myelopathy caused by ossification of the yellow ligament (OYL).

Methods: The authors reviewed consequent 12 patients in whom posterior decompressive laminectomies were performed for OYL from 1999 to 2005. Diagnostic imagings including simple radiographs, computed tomography and magnetic resonance images were performed in each case. The patients were reviewed to evaluate the clinical presentation, surgical outcome and complications of the operation.

Results: In all patients, OYL was located in the lower thoracic region and all patients presented with numbness on both limbs and pain. Among them, 5 patients presented with gait disturbance due to paraparesis and two patients had sphincter dysfunction. Decompressive laminectomy through a posterior approach using microscope resulted in improvement of symptoms in all patients, but, recovery was incomplete in a half of the patients. The mean postoperative Japanese orthopaedics association (JOA) score was 7.9 when compared with 4.9 in preoperative assessment and the mean recovery rate was 65%. Dural tear was noticed in four patients, so dural repair was performed, but there were no neurological deficits related to neural injury.

Conclusion: OYL is an uncommon cause of myelopathy but it can lead to debilitating thoracic myelopathy. Careful decompressive laminectomy can achieve favorable results.

No MeSH data available.


Related in: MedlinePlus

A 67-year old female patient (case 3). A & B: Fat suppression magnetic resonance image and computed tomography scan show fresh compression fracture at T11 level and ossification of yellow ligament at T10-T11 level.
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Figure 3: A 67-year old female patient (case 3). A & B: Fat suppression magnetic resonance image and computed tomography scan show fresh compression fracture at T11 level and ossification of yellow ligament at T10-T11 level.

Mentions: The range of recovery rate was from 35% to 90% and the mean was 65%. MRI showed the existence of a hyperintense signal in the spinal cord in 2 patients (case 4 & case 9) and also showed the association of OYL with narrowing of the lumbar spinal canal in 3 patients (case 2, case 7 & case 10). Two patients (case 3 & case 9), who had been asymptomatic all along became paraparesis after she slipped down. Five patients presented with gait disturbance due to paraparesis and two patients had sphincter dysfunction. MRI scan revealed OYL accompanying osteoporotic compression fracture at T10 level (Fig. 3). Posterior decompressive laminectomies were performed. Dural tear was noticed in four patients as an attempt was made to dissect the adhesion of the dura. Dural repair by artificial dural graft was performed, and fibrin glue was injected. There was no sign of persistent cerebrospinal fluid leakage and meningocele. Moreover, neither postlaminectomy kyphotic deformity nor deep wound infection was identified in the present study. At microscopic evaluation of the operative specimens, there was evidence of a progressive disappearance of the ligament tissue replaced by mature lamellar bone through a process of enchondral ossification.


Symptomatic myelopathy caused by ossification of the yellow ligament.

Park DA, Kim SW, Lee SM, Kim CG, Jang SJ, Ju CI - Korean J Spine (2012)

A 67-year old female patient (case 3). A & B: Fat suppression magnetic resonance image and computed tomography scan show fresh compression fracture at T11 level and ossification of yellow ligament at T10-T11 level.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430561&req=5

Figure 3: A 67-year old female patient (case 3). A & B: Fat suppression magnetic resonance image and computed tomography scan show fresh compression fracture at T11 level and ossification of yellow ligament at T10-T11 level.
Mentions: The range of recovery rate was from 35% to 90% and the mean was 65%. MRI showed the existence of a hyperintense signal in the spinal cord in 2 patients (case 4 & case 9) and also showed the association of OYL with narrowing of the lumbar spinal canal in 3 patients (case 2, case 7 & case 10). Two patients (case 3 & case 9), who had been asymptomatic all along became paraparesis after she slipped down. Five patients presented with gait disturbance due to paraparesis and two patients had sphincter dysfunction. MRI scan revealed OYL accompanying osteoporotic compression fracture at T10 level (Fig. 3). Posterior decompressive laminectomies were performed. Dural tear was noticed in four patients as an attempt was made to dissect the adhesion of the dura. Dural repair by artificial dural graft was performed, and fibrin glue was injected. There was no sign of persistent cerebrospinal fluid leakage and meningocele. Moreover, neither postlaminectomy kyphotic deformity nor deep wound infection was identified in the present study. At microscopic evaluation of the operative specimens, there was evidence of a progressive disappearance of the ligament tissue replaced by mature lamellar bone through a process of enchondral ossification.

Bottom Line: Among them, 5 patients presented with gait disturbance due to paraparesis and two patients had sphincter dysfunction.The mean postoperative Japanese orthopaedics association (JOA) score was 7.9 when compared with 4.9 in preoperative assessment and the mean recovery rate was 65%.Dural tear was noticed in four patients, so dural repair was performed, but there were no neurological deficits related to neural injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Republic of Korea.

ABSTRACT

Objective: This study was performed to describe the clinical presentation, surgical outcome in patients with symptomatic myelopathy caused by ossification of the yellow ligament (OYL).

Methods: The authors reviewed consequent 12 patients in whom posterior decompressive laminectomies were performed for OYL from 1999 to 2005. Diagnostic imagings including simple radiographs, computed tomography and magnetic resonance images were performed in each case. The patients were reviewed to evaluate the clinical presentation, surgical outcome and complications of the operation.

Results: In all patients, OYL was located in the lower thoracic region and all patients presented with numbness on both limbs and pain. Among them, 5 patients presented with gait disturbance due to paraparesis and two patients had sphincter dysfunction. Decompressive laminectomy through a posterior approach using microscope resulted in improvement of symptoms in all patients, but, recovery was incomplete in a half of the patients. The mean postoperative Japanese orthopaedics association (JOA) score was 7.9 when compared with 4.9 in preoperative assessment and the mean recovery rate was 65%. Dural tear was noticed in four patients, so dural repair was performed, but there were no neurological deficits related to neural injury.

Conclusion: OYL is an uncommon cause of myelopathy but it can lead to debilitating thoracic myelopathy. Careful decompressive laminectomy can achieve favorable results.

No MeSH data available.


Related in: MedlinePlus