Compressive Myelopathy Research Articles

The Improvement of Intraoperative Motor Evoked Potential after Decompression in Cervical Compressive Myelopathy: Its Significance and Related Factors

Objective: This study investigated the relationship between intraoperative motor evoked potential (MEP) improvement after decompression surgery for cervical compressive myelopathy (CCM) and postoperative neurological outcomes, and preoperative factors influencing MEP improvement.Methods: MEP amplitudes were measured prospectively before and after decompression in 38 patients with CCM. The patients were categorized into three groups according to whether the intraoperative MEP slightly decreased, slightly increased, or significantly increased. Functional outcomes were assessed using the recovery rate (RR) and absolute improvement (AI) of the modified Japanese Orthopaedic Association score on postoperative days (PODs) 7 and 28. The preoperative characteristics and intraoperative MEP changes among the three groups were compared. Additionally, the correlation between the increase in MEP amplitude during surgery and the extent of improvement in functional outcomes was investigated.Results: The significantly increased MEP group had a lower baseline MEP amplitude (152.46 µV; p=0.009). In the slightly decreased MEP group, the RR was 27.98 ± 32.29% at POD 7 (p=0.010) and 11.61 ± 69.84% at POD 28 (p=0.200); the AI was 0.79 ± 0.80 at POD 7 (p=0.010) and 0.79 ± 1.42 at POD 28 (p=0.100). In the slightly increased MEP group, the RR was 23.75 ± 28.36% at POD 7 (p=0.040) and 28.47 ± 43.38% at POD 28 (p=0.070); the AI was 1.00 ± 1.21 at POD 7 (p=0.030) and 1.08±1.88 at POD 28 (p=0.100). In the significantly increased MEP group, the RR was 41.06 ± 32.01% at POD 7 (p=0.009) and 59.78 ± 34.52% at POD 28 (p=0.006); the AI was 3.08 ± 2.07 at POD 7 (p=0.009) and 4.33 ± 2.54 at POD 28 (p=0.006). Greater intraoperative MEP improvement correlated with better postoperative recovery at 1 month (RR, p=0.010; AI, p<0.001).Conclusion: Intraoperative MEP monitoring is valuable for predicting postoperative neurological outcomes in CCM patients, particularly those with lower baseline MEP amplitudes. Significant intraoperative MEP improvements are associated with better functional recovery. These findings underscore the importance of MEP monitoring in optimizing surgical strategies and predicting neurological recovery.

Cervical motion analysis using wearable inertial sensors to patients with cervical ossification of posterior longitudinal ligament.

This study aimed to clarify cervical kinematics during daily activities, including level walking and stair ascending, in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL). Eighteen patients with myelopathy caused by C-OPLL and 18 healthy controls were recruited to participate in the study. The sagittal cervical kinematics during level walking and stair ascent were quantitatively assessed using a motion analysis system based on wearable inertial sensors. The Japanese Orthopaedic Association score, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, Neck Disability Index, and deep sensation in the lower extremities were assessed in all participants. Nine of 18 patients with C-OPLL presented with deep sensory disturbances. Patients with C-OPLL with deep sensory disturbances exhibited different sagittal plane cervical motion patterns than healthy controls during level walking and stair ascent. During the first phase of stair ascent, both patients with C-OPLL and healthy controls flexed their necks to the same degree; however, during the middle and final phases of stair ascent and all phases of level walking, the mean cervical flexion angle of patients with C-OPLL with deep sensory disturbances was significantly higher than that of patients with C-OPLL without deep sensory disturbance and healthy controls. Our data suggest that patients with C-OPLL presenting with deep sensory disturbances are likely to walk with their necks flexed and gaze downward to observe their steps throughout their daily lives. This habitual neck posture may lead to a vicious cycle of cervical kyphosis and worsening of compressive myelopathy.

Pediatric spinal arachnoid cysts with compressive myelopathy: single-center experience and update on surgical management.

This study describes the surgical outcome of pediatric primary spinal arachnoid cysts (SACs) presenting with compressive myelopathy and gives an update on the classification and management of these rare lesions. We performed a single-center retrospective analysis of pediatric patients operated for primary spinal arachnoid cysts. The clinical and radiologic profiles and surgical outcomes of these children were analyzed. Subgroup analysis was done in the laminoplasty vs laminectomy groups to see for the development of spinal deformity. There were 10 males and seven females with a mean age of 10.4years (range:6-14years). The cysts extended to an average of 5.2 levels (range:2-8). They were extradural in seven (41%) and intradural in 10 (59%). Six intradural and four extradural cysts underwent laminectomy (n = 10) while four intradural and three extradural cysts underwent laminoplasty (n = 7). Although three out of 10 cases in the laminectomy group and none in the laminoplasty group had post-operative spinal deformity, this result was not statistically significant (p = 0.110). There was a moderate negative correlation between post-operative cord occupancy ratio (COR) and post-operative McCormick grade (Pearson correlation coefficient = -0.453, p = 0.068), suggesting that higher CORs are associated with lower McCormick grades. Symptomatic pediatric primary spinal arachnoid cysts are safely and effectively managed by marsupialization or microsurgical excision. Considering the growing age group, laminoplasty rather than laminectomy should be the standard surgical procedure to prevent late postoperative spinal deformity. Clinically significant recurrences are rare in the setting of adequate cord expansion and restored subarachnoid CSF flow following surgery.

Fluorosis Masquerading as Compressive Myelopathy

A 60-year-old woman from Cuddalore presented with restricted neck movements, progressive difficulty in walking, and lower limb weakness, leading to bed confinement. Clinical examination revealed spastic paraparesis, brisk reflexes, and sensory deficits below the hips. Laboratory investigations indicated renal insufficiency and elevated urine fluoride levels. Imaging demonstrated calcifications of sacroiliac, sacrospinous ligaments, interosseous membrane, and posterior longitudinal ligament, with osteosclerosis and osteoporosis. Differential diagnoses included Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis. However, the unique pattern of ligament calcification and elevated fluoride levels supported a diagnosis of fluorosis. This case underscores the importance of considering fluorosis in patients from endemic areas with spastic paraparesis and characteristic radiological findings. Posterior decompression via laminectomy was performed, emphasizing the need for awareness of fluorosis as a potential cause of cervical compressive myelopathy.

Surgical treatment of spinal neurenteric cysts

Background. Spinal neurenteric cysts are very rare benign space-occupying lesions in the vertebral canal emerging due to anomalies of neural tube development during prenatal development of the fetus. Clinically, neurenteric cysts can manifest both in childhood and adulthood.Aim. To evaluate the results of surgical treatment of adult patients with spinal neurenteric cysts who were operated on at the Neurosurgery Division of the Clinic of Nervous System Diseases of the I.M. Sechenov First Moscow State Medical University.Materials and methods. The study group included 3 patients (2 women and 1 man) with mean age of 33 years. The main diagnosis method was magnetic resonance imaging. In all cases, radical cyst resection was performed with subsequent histological examination of cyst walls.Results. In all observations, cyst walls had local areas of increased density and thickness: a distinctive solid component accumulating the contrast agent in magnetic resonance images. This type of structure is considered extremely rare per descriptions presented in literature, but in our case series it was detected in all patients. Cyst resection led to pain syndrome regression and almost full regression of clinical manifestations of spinal cord compression which justifies active surgical tactics in this pathology.Conclusion. Neurenteric cyst of the vertebral canal can cause spinal cord compression. The main diagnostic method of this pathology is magnetic resonance imaging, however magnetic resonance semiotics of these cyst has not been standardized. The presence of constant pain syndrome without marked clinical signs of compression myelopathy is sufficient reason for cyst resection surgery. Cyst resection allowsto achieve regression of pain syndrome and neurological abnormalities caused by spinal cord compression.

Clinical spectrum of tuberculosis in adolescents (10–19 years) in a tertiary care center of North India

Background\\objectivesThere is limited literature available to characterize tuberculosis (TB) in adolescents despite them sharing a high burden of the disease. Ours is the first prospective study in India and worldwide to study the clinical profile of tuberculosis in adolescents aged 10–19 years.Methods: We enrolled 82 children and adolescents between March 2021 to March 2022. The diagnosis of TB was made on the basis of National Tuberculosis Elimination Program (NTEP) guidelines 2020. Adolescents were divided into 3 age groups: early (10–13 years), middle (14–17 years), and late adolescents (18–19 years)and the results were compared among the three groups. A two-sided p value of <0.05 was considered statistically significant.Results: The middle age adolescents comprised majority of our study population and females were more than males. The common presenting features were fever, chest pain, breathing difficulty with majority belonging to lower socioeconomic status. The pulmonary TB accounted for 56% and extrapulmonary constituted 44% of the cases. The notable extrapulmonary cases were disseminated TB with secondary lymphangiectasia, compressive myelopathy, sacroiliac joint arthropathy among others. Infiltrates/consolidation were the most frequent radiological findings in patients with pulmonary TB. The microbiological confirmation was available in 44% of the cases. The microbiological positivity was higher in histopathological specimens and in late adolescents. Two patients were rifampicin resistant. Conclusion: There was a varied clinical presentation of TB in this population. The extrapulmonary cases as well as the microbiological yield increased with increasing age of the cases.

Role of minimal F-wave latency in the electrodiagnosis of polyneuropathy

Background and objective: Polyneuropathy is a debilitating condition that causes damage to more than two peripheral nerves in the body. The objective of this research was to detect the role of minimal F-wave latency as compared with other nerve conduction parameters for the electro-diagnosis of polyneuropathies. Methods: In this descriptive, prospective cross-sectional study, 80 consecutive patients with clinical diagnosis of polyneuropathy (both acute and chronic) between July and December 2023, presenting to the Neurology Department at King Edward Medical University were enrolled. Patients with clinical diagnosis of cervical/lumbar radiculopathies, plexopathies, compressive myelopathy , neuromuscular junction diseases, motor neuron disorders, or localized neuropathies were excluded from this research. NCS and EMG were carried out using conventional procedure. The results were recorded in the predesigned pro forma along with the history and demographic information. Statistical software SPSS 25.0 was used for the analysis of the recorded data. Results: F-wave abnormality was detected in 57 (71.3%) for median nerve, 57 (71.3%) for ulnar nerve, 79 (98.7%) for tibial nerve and in 79 (98.7%) patients for peroneal nerve. Nerve-specific motor nerve conduction study (MNCS) abnormality was found in 47 (58.8%) for median nerve, 43/80 (53.8%) for ulnar nerve, 59 (73.7%) for tibial nerve and in 57(71.3%) patients for peroneal nerve. Nerve-specific sensory nerve conduction study (SNCS) abnormality was present in 43 (53.3%) for median nerve, 43 (53.3%) for ulnar nerve, 50 (62.5%) for sural nerve, and in 49 (61.3%) patients for superficial peroneal nerve. Overall rate of abnormality was 85% for F-wave minimal latencies in comparison with 64% for MNCS and 56% for SNCS. Conclusion: Minimal F-wave latency can be an effective diagnostic parameter for detection of polyneuropathy. This can facilitate in early detection and management of polyneuropathy.

Anesthetic Challenges in Hirayama Disease Patients Undergoing Cervical Spine Surgery—A Case Series

AbstractHirayama disease (HD) is a rare disease, resulting from cervical compressive myelopathy, manifesting as upper limb muscular atrophy, and rarely autonomic and upper motor neuron signs. Anesthesia management is challenging—careful neck positioning during bag-mask ventilation and endotracheal intubation, avoidance of drugs that release histamine, multimodal monitoring to avoid delayed recovery, anticipation of hypotension, and blood loss due to autonomic dysfunction—all this is necessary for successful outcome of general anesthesia in HD patients. This case series demonstrates that preexisting autonomic dysfunction in HD patients should alert the anesthesiologists regarding higher likelihood of hemodynamic perturbations and blood loss, compared with patients who have normal autonomic functions, and henceforth take appropriate precautionary measures.

Changes in Intramedullary Increased Signal Intensity on Axial T2-weighted MRI After Laminoplasty for Cervical Spondylotic Myelopathy: A 10-year Follow-up Study.

A retrospective study. To investigate whether the preoperative classification and changes in the intramedullary increased signal intensity (ISI) on axial T2-weighted magnetic resonance imaging (MRI) reflect the postoperative functional outcome in patients after laminoplasty for cervical spondylotic myelopathy (CSM). Although patients with CSM exhibit ISI on axial MRI, the association between ISI (preoperative classification and changes) and surgical outcomes has not been investigated. We retrospectively included patients with CSM who underwent MRI preoperatively and at least 10 years postoperatively after laminoplasty between January 2009 and December 2010. According to axial images for the cervical compressive myelopathy (Ax-CCM) system, the ISI on axial images was classified as follows: type 0, normal; type 1, diffuse; type 2, fuzzy focal; and type 3, discrete focal. Functional outcomes, as measured by the Japanese Orthopaedic Association (JOA) score and JOA recovery rate, were evaluated based on the Ax-CCM classification. Forty-three patients were enrolled. The mean follow-up time was 11.0±1.0 years. At the final follow-up, postoperative changes in the type of ISI were observed in 62.8% of patients. The type of ISI improved in 5 patients (11.6%), remained unchanged in 16 patients (37.2%), and worsened in 22 patients (51.2%). Patients with preoperative type 2 ISI had worse postoperative JOA scores and JOA recovery rates than those with other types. A worse ISI type was related to a lower postoperative JOA score and a lower recovery rate at the final follow-up. Type 2 ISI was associated with poor postoperative symptoms and low postoperative function improvement. ISI changed after laminoplasty in 27 patients (62.8%), and worsened ISI was related to poor surgical outcomes.

CT myelography by intrathecal injection of contrast medium though percutaneous administration route visualizes compressed cervical spinal cord in a mouse

BackgroundChronic compressive myelopathy (CCM) is a major cause of spinal cord disorders in the elderly, in which the spinal cord is compressed by bony or soft tissue structures. Although computed tomography myelography (CTM) has been clinically used for the diagnosis of CCM, a method of CTM in rodents remains to be developed. New methodA 50 μl Hamilton syringe attached to a disposable needle was percutaneously inserted into the subarachnoid space (cisterna magna) between the occipital bone and C1 lamina in an anesthetized adult mouse, followed by the injection of contrast medium and CT imaging. ResultsCTM clearly visualized the shape of the spinal cord of intact mice and tiptoe-walking Yoshimura (Twy) mice without any health issues. Comparison with existing method(s)Unlike histology, the current method functions in live mice, directly depicts the compressed spinal cord, and provides clinically related image information. Furthermore, the intrathecal administration of contrast medium through the percutaneous route makes CTM less invasive and takes less time than a conventional intrathecal injection method. ConclusionsThe CTM method used in the present study enables clear visualization of the shape of the dural sac and spinal cord and is useful when conducting experiments on CCM and other spinal diseases in rodents.

Retraction: Determination of the Efficiency of Magnetic Resonance Imaging in the Evaluation of Compressive Myelopathy.

[This retracts the article DOI: 10.7759/cureus.57874.].

Delayed Presentation of Intradural Extramedullary Tuberculoma of Spine in an Immunocompetent MDR-TB Patient

Abstract Intradural spinal tuberculoma is a rare entity, constituting &lt;5% of CNS tuberculoma, whereas intradural extramedullary tuberculoma of spinal cord (IETSC) is even less frequently encountered. Here, we report a case of IETSC at two noncontiguous levels in spinal cord presenting with compressive myelopathy in a patient on multidrug-resistant tuberculosis (MDR-TB) treatment. Surgical decompression and appropriate ATT regimen resulted in gradual return to near-normal neurological function with no functional disability. To our knowledge, this is the first case report of IETSC developing in an immunocompetent patient on MDR regimen for drug resistant sputum-positive pulmonary tuberculosis.

Neurofibromatosis to neoplasia transition: a rare case report of spindle cell malignant peripheral nerve sheath tumor with literature review

Introduction and Importance: Malignant peripheral nerve sheath tumor (MPNST) is a rare and aggressive soft tissue malignant tumor. MPNST in the spinal canal are rarely seen except in cases with NF1. But a long segment extradural spinal malignant spindle cell neoplasm has not been reported in current literature. Case Presentation: We present the first reported case of spinal malignant spindle cell neoplasm extended along the spine. The detected lesion is responsible for compressing various segments of the spinal cord, causing thinning of the cord and secondary stenosis of the spinal canal, leading to a condition known as multi-segment compression myelopathy. Clinical Discussion: MPNSTS are typically detected late due to nonspecific symptoms, with a higher incidence in extremities and a notable occurrence in unusual locations. Diagnosis relies on MRI and histopathology, with S_100 positivity as a neural marker. MPNSTs can arise from neurofibromas or Schwann cells, with a significant portion resulting from TP53 mutations or secondary to radiation exposure. Conclusion: This case stands out due to its unique presentation, characterized by a predominantly spindle cell morphology with certain epithelioid features. It is imperative to recognize this condition for an accurate diagnosis, emphasizing the spindle cell-type malignant peripheral nerve sheath tumor (MPNST) and highlighting its exceptionally poor prognosis.

21 cm long intra-medullary tuberculoma of dorsal spinal cord

Intramedullary tuberculoma (IMT) is a rare form of spinal tuberculosis. The incidence of this disease is 01-02/100,000 patients (1). Occurs by hematogenous dissemination from focus elsewhere in the body. Magnetic resonance imaging (MRI) is helpful for diagnosing IMT at an early stage and it is also very useful in follow-up. CSF PCR studies are confirmatory. Histopathology is the Gold Standard. AKT drug therapy is the mainstay of treatment for IMT, with surgery indicated in select patients. Here, we describe a female patient with long-segment dorsal intramedullary tuberculoma with compressive myelopathy treated with surgery and put on AKT who improved clinically.

A fresh look at the SarcoFluor antibody test for the detection of specific antibodies to Sarcocystis neurona for the diagnosis of equine protozoal myeloencephalitis

Equine protozoal myeloencephalitis (EPM) is a challenging disease to diagnose in horses with neurological signs. To optimize contemporary diagnostic testing, including the use of serum:CSF antibody ratios, the SarcoFluor antibody test for Sarcocystis neurona requires revalidation. The SarcoFluor, a previously validated immunofluorescent antibody test (IFAT) for the detection of antibodies specific to S. neurona in serum and cerebrospinal fluid (CSF) of naturally infected horses was analyzed using recent data and considering a serum:CSF antibody ratio threshold. Utilization of serum and CSF phosphorylated neurofilament heavy protein (pNfH) concentrations in support of an EPM diagnosis was also evaluated. 172 horses were divided into three groups: EPM-positive horses (EPM+, n=42), neurological non-EPM horses (n=74) confirmed with non-EPM neurological diseases (cervical vertebral compressive myelopathy, equine neuroaxonal dystrophy/equine degenerative myeloencephalopathy), and control horses (control, n=56) without neurological signs and neurological abnormalities on histology. Logistic regression was used to compare EPM diagnostic regimens. Specifically, EPM+ horses were compared with neurological non-EPM horses showing neurological signs. To consider diagnostic utility, post-test probabilities were calculated by titer. When differentiating between EPM and other neurological diseases, the combination of serum and CSF SarcoFluor testing added more information to the model accuracy than either test alone. Using serum and CSF for pNfH in support of an EPM diagnosis did not identify cutoffs with statistically significant odds ratios but increased the overall model accuracy when used with the IFAT. Utilization of IFAT titers against S. neurona in serum and CSF result in a high post-test probability of detecting EPM+ horses in a clinical setting.

SYSTEMATIC REVIEW OF AUTONOMIC AND RESPIRATORY IMPAIRMENTS IN CERVICAL COMPRESSIVE MYELOPATHY

Background: Cervical myelopathies are progressive conditions caused by chronic compression of the spinal cord due to degenerative changes or other structural factors. While motor impairments are the predominant symptoms, disruption of autonomic and respiratory pathways in the spinal cord can lead to dysfunction in these systems as well. This systematic review aimed to comprehensively evaluate the evidence on autonomic and pulmonary dysfunction occurring in patients with cervical compressive myelopathies. Methods: We systematically searched major electronic databases including MEDLINE, Embase, and CENTRAL for studies reporting on autonomic or pulmonary impairments in adults with degenerative cervical myelopathy, ossification of the posterior longitudinal ligament, or other cervical compressive myelopathies. Screening, data extraction and quality assessments were conducted in duplicate. Findings were synthesized narratively. Results: 28 studies (n=1,642 patients) met eligibility criteria. Autonomic dysfunctions identified included abnormal heart rate variability parameters, altered sweating/temperature regulation, neurogenic bladder, and erectile dysfunction. The pooled prevalence of neurogenic bladder among 8 studies was 48% (95% CI 33-62%). For pulmonary dysfunction, diaphragmatic paralysis and respiratory failure requiring ventilator support was relatively uncommon (&lt;10%) but sleep disordered breathing and decreased respiratory muscle strength were more prevalent (20-50% range). Both autonomic and pulmonary impairments correlated with increased myelopathy severity, particularly among patients with lesions involving the lower cervical cord. Conclusions: Autonomic and pulmonary deficits occur in a substantial subset of patients with cervical myelopathies, frequently correlating with lesion severity. Screening and management of these non-motor impairments is important for optimizing functional status and quality of life. Additional high-quality research on the epidemiology, mechanisms, and clinical implications of these complications is needed.

Cervical Disc Arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF) for Two-Level Cervical Disc Degenerative Disease: An Updated Systematic Review and Meta-Analysis.

Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are both considered to be efficacious surgical procedures for treating cervical spondylosis in patients with or without compression myelopathy. This updated systematic review and meta-analysis aimed to compare the outcomes of these procedures for the treatment of cervical degenerative disc disease (DDD) at two contiguous levels. Methods: The PubMed, EMBASE, and Cochrane CENTRAL databases were searched up to 1 May 2023. Studies comparing the outcomes between CDA and ACDF in patients with two-level cervical DDD were eligible for inclusion. Primary outcomes were surgical success rates and secondary surgery rates. Secondary outcomes were scores on the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, as well as the Japanese Orthopaedic Association (JOA) score for the severity of cervical compression myelopathy and complication rates. Results: In total, eight studies (two RCTs, four retrospective studies, and two prospective studies) with a total of 1155 patients (CDA: 598; ACDF: 557) were included. Pooled results revealed that CDA was associated with a significantly higher overall success rate (OR, 2.710, 95% CI: 1.949-3.770) and lower secondary surgery rate (OR, 0.254, 95% CI: 0.169-0.382) compared to ACDF. In addition, complication rates were significantly lower in the CDA group than in the ACDF group (OR, 0.548, 95% CI: 0.326 to 0.919). CDA was also associated with significantly greater improvements in neck pain VAS than ACDF. No significant differences were found in improvements in the arm VAS, NDI, and JOA scores between the two procedures. Conclusions: CDA may provide better postoperative outcomes for surgical success, secondary surgery, pain reduction, and postoperative complications than ACDF for treating patients with two-level cervical DDD.

Intraoperative and Postoperative Ultrasonographic Spinal Cord Evaluation of Cervical Double-Door Laminoplasty.

Ultrasonography is a useful tool for the localization, morphology, and characterization of lesions and is increasingly being applied to spinal cord evaluation in cervical spine diseases. However, in conventional cervical laminoplasty, detailed evaluation is difficult because of ultrasound attenuation. Therefore, the purpose of this study was to perform a cervical laminoplasty using a modified surgical technique and evaluate the spinal cord. The spinal cord was evaluated intraoperatively and one week postoperatively in 11 patients with cervical compressive myelopathy. Double-door laminoplasty was selected as the surgical method, and the shape and placement of the bone graft between the expanded laminas were devised to reduce ultrasonic attenuation, such that there was a large space in which the dura mater was visible. Intraoperative and postoperative spinal cord decompression, claudication, and pulsation were confirmed in all cases. A more precise diagnosis was possible using ultrasound attenuation using the grafted bone between the laminas as an indicator. Intraoperative and postoperative spinal cord decompression status and wave patterns of modified cervical double-door laminoplasty can be evaluated using ultrasonography. Ultrasound-based evaluations of the spinal cord may provide new insights.

Imaging diagnosis: Disseminated hemangiosarcoma in a Welsh pony.

A 16-year-old pony gelding presented with epistaxis and a head tilt. Referral skull radiographs suggested an ethmoid hematoma. Concurrent neurologic abnormalities prompted contrast-enhanced CT of the head and cranial neck, revealing numerous hyperattenuating masses throughout the brain and paranasal sinuses, along with a large osteolytic mass in the second cervical vertebra. The vertebral mass extended into the vertebral canal, causing focal extradural compressive myelopathy. These findings were inconsistent with ethmoid hematoma and metastatic hemangiosarcoma or malignant melanoma were prioritized as potential causes for the clinical signs. Postmortem examination confirmed the sinonasal, intracranial, and vertebral masses as hemangiosarcoma, and additionally revealed innumerable thoracoabdominal metastatic lesions and hemorrhagic foci. A final diagnosis of disseminated hemangiosarcoma was made. In this study, CT proved invaluable for evaluating the severity and characterizing regional disease and neural involvement, directly affecting case management decisions.

Differences in the Demographics and Clinical Characteristics between the Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum in Patients Who Underwent Thoracic Spinal Surgery for Compressive Myelopathy.

Ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) are related diseases associated with the ossification of spinal ligaments that can occasionally lead to thoracic myelopathy. We retrospectively analyzed the clinical data of 34 consecutive patients who underwent thoracic spinal surgeries for OPLL and/or OLF at our hospital between July 2010 and June 2022, and statistically compared data between patients with thoracic OPLL (TOPLL; n = 12) and those with thoracic OLF (TOLF; n = 22). The mean age of the TOPLL group was significantly lower than that of the TOLF group (53.7 vs. 68.4 years). The TOPLL group exhibited a greater female predominance than the TOLF group (58.3% vs. 18.2%). The median body mass index of the TOPLL group was significantly higher than that of the TOLF group (33.0 vs. 26.0 kg/m2). Patients with TOPLL significantly required instrumented fusion and repetitive surgical intervention more than those with TOLF (83.3% vs. 9.1%; 50.0% vs. 0.0%). Although neurological deterioration just after the intervention was more common in patients with TOPLL (41.7% vs. 4.6%), no difference was observed in thoracic Japanese Orthopaedic Association score and recovery rate in the chronic phase between TOPLL and TOLF. The TOPLL group had a younger onset, female dominance, and a greater degree of obesity when compared with the TOLF group. The surgery for TOPLL is challenging, considering that it requires long-range decompression and fusion, subsequent operations, careful management, and long-term follow-up, when compared to TOLF, which necessitates only simple decompression.