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Spinal fixation as treatment of ossified posterior longitudinal ligament.

Goel A - J Craniovertebr Junction Spine (2015 Jul-Sep)

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, Maharashtra, India.

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Ossified posterior longitudinal ligament is a relatively rare, but a crippling disorder... More importantly, the lesion is relatively difficult and potentially “dangerous” to treat surgically... This is more because the exact pathogenesis of the disease process is unclear... The complications of surgery can be devastating to the patient and can even be life-threatening... No surgeon who is dealing with this issue can say with confidence that he has got the final answer to the problem, and the results of his proposed treatment are uniformly satisfying... We had recently discussed that vertical instability at the facets is the point of the genesis of degenerative spinal disorders... Imaging features of multiple-segment OPLL and cord compression can present a grotesque clinical situation... However, we have realized that the neural tissues in general and spinal cord, in particular, can tolerate significant compression when the pathology is long-standing and develops over a period of time... However, instability and repeated micro-injuries can result in cord damage and in related symptoms... However, we have realized that it may sometimes be better to fix the spinal segment beyond the spinal extent of OPLL... A remarkable clinical improvement was observed in our patients with this method of treatment... Longer follow-up will be mandatory to confirm that only fixation can be the best form of treatment for OPLL... However, our initial results are encouraging... Despite our enthusiasm due to gratifying clinical results, a long-term assessment of these patients will be mandatory to assess if stabilization assists in reversing only the dynamic component of the disease process or it also participates in affecting the growth characteristics or growth potential of OPLL.

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(a) Sagittal image of computed tomography scan of a 32-year-old male patient. He suffered road traffic accident 10 years prior to treatment. The symptoms of quadriparesis increased over the period of time. The image shows chronic odontoid fracture. (b) Lateral sagittal image showing ossified posterior longitudinal ligament at C2-C3 level. (c) Postoperative image showing distraction, reduction and fixation of the atlantoaxial joint. (d) Images showing the implant in the facets
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Figure 1: (a) Sagittal image of computed tomography scan of a 32-year-old male patient. He suffered road traffic accident 10 years prior to treatment. The symptoms of quadriparesis increased over the period of time. The image shows chronic odontoid fracture. (b) Lateral sagittal image showing ossified posterior longitudinal ligament at C2-C3 level. (c) Postoperative image showing distraction, reduction and fixation of the atlantoaxial joint. (d) Images showing the implant in the facets

Mentions: OPLL is identified throughout the world, but the reports from Asia outnumber those from other continents. Dietary, environmental and physical body constitution related factors, apart from a host of other possible etiological factors have been suggested to be the possible causes. In general, the patients harboring OPLL are marginally or significantly obese and have a relatively sedate lifestyle. We recently hypothesized the factor of spinal instability as the primary issue that is responsible for genesis and growth of OPLL. Long-standing subtle and persistent spinal instability was identified to be the principle or the only initiating and causative factor.[1] We identified old fractures of the odontoid process having subtle instability presenting with OPLL in the adjoining segments [Figure 1]. Also, we have identified OPLL in cases with basilar invagination with long-standing instability [Figure 2].


Spinal fixation as treatment of ossified posterior longitudinal ligament.

Goel A - J Craniovertebr Junction Spine (2015 Jul-Sep)

(a) Sagittal image of computed tomography scan of a 32-year-old male patient. He suffered road traffic accident 10 years prior to treatment. The symptoms of quadriparesis increased over the period of time. The image shows chronic odontoid fracture. (b) Lateral sagittal image showing ossified posterior longitudinal ligament at C2-C3 level. (c) Postoperative image showing distraction, reduction and fixation of the atlantoaxial joint. (d) Images showing the implant in the facets
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4530516&req=5

Figure 1: (a) Sagittal image of computed tomography scan of a 32-year-old male patient. He suffered road traffic accident 10 years prior to treatment. The symptoms of quadriparesis increased over the period of time. The image shows chronic odontoid fracture. (b) Lateral sagittal image showing ossified posterior longitudinal ligament at C2-C3 level. (c) Postoperative image showing distraction, reduction and fixation of the atlantoaxial joint. (d) Images showing the implant in the facets
Mentions: OPLL is identified throughout the world, but the reports from Asia outnumber those from other continents. Dietary, environmental and physical body constitution related factors, apart from a host of other possible etiological factors have been suggested to be the possible causes. In general, the patients harboring OPLL are marginally or significantly obese and have a relatively sedate lifestyle. We recently hypothesized the factor of spinal instability as the primary issue that is responsible for genesis and growth of OPLL. Long-standing subtle and persistent spinal instability was identified to be the principle or the only initiating and causative factor.[1] We identified old fractures of the odontoid process having subtle instability presenting with OPLL in the adjoining segments [Figure 1]. Also, we have identified OPLL in cases with basilar invagination with long-standing instability [Figure 2].

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, Maharashtra, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Ossified posterior longitudinal ligament is a relatively rare, but a crippling disorder... More importantly, the lesion is relatively difficult and potentially “dangerous” to treat surgically... This is more because the exact pathogenesis of the disease process is unclear... The complications of surgery can be devastating to the patient and can even be life-threatening... No surgeon who is dealing with this issue can say with confidence that he has got the final answer to the problem, and the results of his proposed treatment are uniformly satisfying... We had recently discussed that vertical instability at the facets is the point of the genesis of degenerative spinal disorders... Imaging features of multiple-segment OPLL and cord compression can present a grotesque clinical situation... However, we have realized that the neural tissues in general and spinal cord, in particular, can tolerate significant compression when the pathology is long-standing and develops over a period of time... However, instability and repeated micro-injuries can result in cord damage and in related symptoms... However, we have realized that it may sometimes be better to fix the spinal segment beyond the spinal extent of OPLL... A remarkable clinical improvement was observed in our patients with this method of treatment... Longer follow-up will be mandatory to confirm that only fixation can be the best form of treatment for OPLL... However, our initial results are encouraging... Despite our enthusiasm due to gratifying clinical results, a long-term assessment of these patients will be mandatory to assess if stabilization assists in reversing only the dynamic component of the disease process or it also participates in affecting the growth characteristics or growth potential of OPLL.

No MeSH data available.


Related in: MedlinePlus