Ossification Of Longitudinal Ligament Research Articles

Adult Presentation of X-Linked Hypophosphatemia

Adult X-linked hypophosphatemia (XLH) patients present with specific symptoms, including enthesopathies (e.g., ossification of longitudinal ligaments (OPLL), osteophytes around large joints, and enthesopathy in the Achilles tendons), early osteoarthritis, the development of severe secondary and tertiary hyperparathyroidism (SHPT/THPT), and the subsequent progression of chronic kidney disease (CKD). In addition, these patients exhibit the typical phenotypes of osteomalacia, such as pseudofracture and fracture in weight-bearing bones, odontitis, and tooth abscesses. The mechanism underlying enthesopathy development is unknown; however, a common underlying mechanism among XLH and autosomal recessive hypophosphatemic rickets (ARHR1/2) due to mutations in PHEX, DMP1, and ENPP1 is assumed. Clarification of the pathogenesis and drug discovery for this complication is an urgent issue, as many adult XLH patients suffer subsequent debilitating nervous symptoms or impingement syndrome, and existing treatments are ineffective. Severe SHPT and THPT are associated with conventional therapy, including active vitamin D and phosphate supplementation, and complicated and careful adjustment of dosages by experienced clinicians is required to avoid SHPT/THPT. Burosumab is a very effective therapy without risk for the development of SHPT/THPT. However, indications for this drug should be carefully considered, along with cost-effectiveness, guidelines or recommendations, and the health care system of each country.

Perioperative Complications of Laminoplasty in Degenerative Cervical Myelopathy -A Comparative Study Between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database.

Retrospective cohort study. Laminoplasty (LAMP) is one of the effective methods to successfully achieve surgical decompression in patients with degenerative cervical myelopathy (DCM). However, little evidence exists regarding the perioperative complications in LAMP for patients with ossification of the longitudinal ligament (OPLL) compared with cervical spondylotic myelopathy (CSM). We aimed to investigate the perioperative complication rates and medical costs of DCM, including OPLL and CSM patients who underwent LAMP using a large national inpatient database. This study identified patients who underwent LAMP for OPLL and CSM from 2010 to 2016 using the Japanese Diagnosis Procedure Combination database. We compared the incidence of perioperative complications (systemic and local), reoperation rates, medical costs during hospitalization, and mortality were between the OPLL and CSM groups after propensity score matching. This study included 22,714 patients (OPLL: 7485 patients, CSM: 15,229 patients). Consequently, 7169 pairs were matched. More perioperative systemic complications were detected in the OPLL group (one complication: 9.1% vs 7.7%; P = .002), especially for pneumonia (.5% vs .2%; P = .001) and dysphagia (.5% vs .2%; P = .004). The local complication rate was also higher in the OPLL group (paralysis: 1.1% vs .6%, P = .006; spinal fluid leakage: .4% vs .1%, P = .002). The hospitalization costs were approximately $2300 higher ($19,024 vs $16,770; P < .001) in the OPLL group. More perioperative complications and higher medical costs were noted in patients with OPLL than in patients with CSM who underwent LAMP.

Ossification of the cervical anterior longitudinal ligament is an underdiagnosed cause of difficult airway: a case report and review of the literature

BackgroundOssification of the anterior longitudinal ligament (OALL) of the cervical spine is a common, but rarely symptomatic, condition mostly observed in the geriatric population. Although the condition usually requires no intervention, it could lead to a difficult airway and compromise the patient’s safety.Case presentationHere, we describe the case of a 50-year-old man with cervical myelopathy and OALL that resulted in difficult endotracheal intubation after induction of anesthesia. Radiography and magnetic resonance imaging findings showed OALL, with prominent osteophytes involving four cervical vertebrae, a bulge in the posterior pharyngeal wall, and a narrow pharyngeal space. Airtraq® laryngoscope-assisted intubation was accomplished with rapid induction under sevoflurane-inhaled anesthesia.ConclusionAnesthesiologists should understand that OALL of the cervical spine could cause a difficult airway. However, it is difficult to recognize asymptomatic OALL on the basis of routine airway evaluation guidelines. For susceptible populations, a thorough evaluation of the airway, based on imaging studies and a history of compression symptoms, should be considered whenever possible. In case of unanticipated difficult intubation, anesthesiologists should refer to guidelines for unanticipated difficult airway management and identify OALL of the cervical spine as the cause.

Multivariate analysis of the operative effect on cervical spinal cord injury without fracture or dislocation

To explore the influencing factors of the operative effect on cervical spinal cord injury without fracture or dislocation. The clinical data of 69 patients with cervical spinal cord injury without fracture or dislocation from November 2010 to November 2016 who received operation were retrospectively analyzed. There were 37 males and 32 females, aged from 32 to76 years with an average of (51.6±7.3) years. The clinical data of 12 factors were selected, including age, gender, ASIA grade of spine cord injury, the length of spine cord injury by MRI, Pavlov ratio, ossification of the posterior longitudinal ligament (OPLL), intervertebral disc herniation, type of spine cord injury by MRI, time from injury to operation, treatment of high-dose methylprednisolone, operation time, intraoperative bleeding volume. In order to screen the main influencing factors of above items to prognosis, the single factor and multiple factor Logistic regression analysis were used in the clinical data by SPSS 22.0 statistical software. Univariate analysis results showed that the factors including ASIA grade of spine cord injury, the length of spine cord injury by MRI, Pavlov ratio, ossification of longitudinal ligament, intervertebral disc herniation, the type of spine cord injury by MRI were associated with prognosis (P<0.05). Multi factor analysis of the selected factors indicated that the type of spine cord injury by MRI, the length of spine cord injury by MRI, Pavlov ratio, ASIA grade of spine cord injury were the main prognostic factors according to the influence intensity (P<0.05). The influencing factors of the operative effect on cervical spinal cord injury without fracture and dislocation were the type of spine cord injury by MRI, the length of spine cord injury by MRI, Pavlov ratio, ASIA grade of spine cord injury, and the foremost were the type and length of spine cord injury by MRI. Compared with other patients, preoperative MRI showed the patient with spinal cord injury type with bleeding and edema, or the length of spine cord injury larger than 45 mm may be less effective, therefore, it is necessary to thoroughly communicate with the patients and their kin before surgery.

Multivariate analysis of the operative effect on cervical spinal cord injury without fracture or dislocation

To explore the influencing factors of the operative effect on cervical spinal cord injury without fracture or dislocation. The clinical data of 69 patients with cervical spinal cord injury without fracture or dislocation from November 2010 to November 2016 who received operation were retrospectively analyzed. There were 37 males and 32 females, aged from 32 to76 years with an average of (51.6±7.3) years. The clinical data of 12 factors were selected, including age, gender, ASIA grade of spine cord injury, the length of spine cord injury by MRI, Pavlov ratio, ossification of the posterior longitudinal ligament (OPLL), intervertebral disc herniation, type of spine cord injury by MRI, time from injury to operation, treatment of high-dose methylprednisolone, operation time, intraoperative bleeding volume. In order to screen the main influencing factors of above items to prognosis, the single factor and multiple factor Logistic regression analysis were used in the clinical data by SPSS 22.0 statistical software. Univariate analysis results showed that the factors including ASIA grade of spine cord injury, the length of spine cord injury by MRI, Pavlov ratio, ossification of longitudinal ligament, intervertebral disc herniation, the type of spine cord injury by MRI were associated with prognosis (P<0.05). Multi factor analysis of the selected factors indicated that the type of spine cord injury by MRI, the length of spine cord injury by MRI, Pavlov ratio, ASIA grade of spine cord injury were the main prognostic factors according to the influence intensity (P<0.05). The influencing factors of the operative effect on cervical spinal cord injury without fracture and dislocation were the type of spine cord injury by MRI, the length of spine cord injury by MRI, Pavlov ratio, ASIA grade of spine cord injury, and the foremost were the type and length of spine cord injury by MRI. Compared with other patients, preoperative MRI showed the patient with spinal cord injury type with bleeding and edema, or the length of spine cord injury larger than 45 mm may be less effective, therefore, it is necessary to thoroughly communicate with the patients and their kin before surgery.

Quantitative study of the effect of atlas posterior arch resection on cervical posterior decompression

Objective To quantitatively compare the effect of preservation or removal of atlas posterior arch on cervical posterior decompression, so as to provide a basis for reasonable selection of upper cervical spine decompression range and determination of surgical indications for atlas posterior arch resection. Methods The data of 45 patients with posterior decompression of upper cervical spine were retrospectively analyzed. According to the decompression range, the patients were divided into C2-C7 group and C1-C7 group. There were 25 cases in the C2-C7 group, 19 males and 6 females, with an average age of 56.3 years (40-71 years), 4 cases of cervical spondylotic myelopathy and 21 cases of ossification of the posterior longitudinal ligament of cervical spine. All of the 25 patients underwent open-door laminoplasty: 20 cases with hinge side anchoring procedure and 5 cases with preservation of the unilateral posterior muscular-ligament complex procedure (titanium cable procedure). There were 20 cases in C1-C7 group, 12 males and 8 females, with an average age of 58.4 years (44-75 years). All of the 20 cases underwent atlas posterior arch resection as well as C2-C7 open-door laminoplasty, including anchoring procedure in 1 case, titanium miniplate procedure in 4 cases, and titanium cable procedure in 15 cases. Standardized vertebral-cord distance (SVCD) at each level from atlas to level C6,7 was measured on T2-weighted images of MR on the mid-sagittal plane in the neutral position performed 3-12 months postoperatively at each individual level. As the main outcomes, the SVCD values obtained at the same level of the two groups were compared between the two groups. Shapiro-Wilk normality test was performed on the SVCD values at C1,2 and C2 levels of two groups. The area under the normal distribution curve of SVCDs was used to calculate the corresponding residual compression rate with different magnitude of compression mass to further discover the difference of the decompression effect between the two groups. Results The SVCD obtained at the level of the anterior arch of atlas (C1), the junction of odontoid process and axis (C1,2) and the middle part of axis body (C2) in the C2-C7 group was 9.91±1.34 mm, 8.35±1.27 mm, and 8.22 ±1.43 mm, respectively. The SVCD at the same levels was 11.02±1.60 mm, 9.72±1.24 mm, and 9.12±1.11 mm, respectively. SVCDs differed significantly in the above range between the two groups. However, from level C2,3 to C6,7, there was no significant difference in SVCDs between the two groups. The JOA score of group C2-C7 was 11.8±2.7 preoperatively and increased significantly to 14.7±1.8 at 12 months postoperatively(t=-7.006, P<0.001) with a recovery rate of 57.0%±32.2%. The JOA score of group C1-C7 was 11.7±2.8 preoperatively and increased significantly to 14.2±2.3 at 12 months postoperatively(t=-6.177, P<0.001) with a recovery rate of 51.9%±32.1%. Conclusion Atlas posterior arch resection can significantly increase the decompression effect of posterior cervical surgery from the anterior arch of atlas to the middle part of axis body, but it would not increase the decompression effect at level C2,3 or below. When the magnitude of the ventral compression factor exceeds the decompression limit (8.5 mm) available with C2-C7 decompression in the range from atlas to the middle of the axis body, extending the decompression range by atlas posterior arch resection is an effective means to achieve adequate decompression. Key words: Cervical atlas; Axis; Ossification of posterior longitudinal ligament; Spinal cord compression; Decompression, surgical

A clinical Study of C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplastyinupper cervical ossifi-cation of the posterior longitudinal ligament

Objective To explore the clinical effects of C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplasty in upper cervical(involve or above C2 segment) ossification of the posterior longitudinal ligament. Methods All of 39 patients (22 males and 17 females) withcervical ossification of the posterior longitudinal ligament up to C2 which causedcompression symptoms were operated with posterior cervical surgery in ourhospital from January 2013 to June 2017.The average age was 55.74+7.91 years old, ranging from 39 to 71 years. Among these patients, 21 patients underwent C2 dome-like expansive laminoplasty and 18 underwent C2 expansive open-door laminoplasty, the patients in both groups underwent the C3-C7 expansive open-door laminoplasty. The preoperative and postoperative Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score, the xisual analog scale(VAS) and the space available for the spinal cord (SAC) of C2 segment in X-ray were measured and statistically analyzed. Results All patients were followed up, the follow-up time was from 15 to 63 months (mean 42.3±17.7 months). There was no significant difference in the general condition, NDI, JOA score and JOA score improvement rate between preoperative and postoperative follow-up in 2 groups. There were significant differences in the NDI, JOA, VAS and SAC between preoperative and postoperative follow-up in 2 groups. The VAS score in C2 dome-like expan-sive laminoplasty group 1.52±1.2 was significantly lower than that in C2 expansive open-door laminoplasty group 2.06±0.87(t=-2.23, P<0.05), while the SAC in C2 expansive open-door laminoplasty group 14.11±1.023 was significantly higher than that in C2 dome-like expansive laminoplasty group 11.86±1.014(t=-6.89, P<0.05). No failure of internal fixation or recurrent compres-sion was found during follow-up. Conclusion For patients with ossification of posterior longitudinal ligament up to C2 or higher level, both C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplasty can achieve good results. The SAC in C2 expansive open-door laminoplastygroup was superior to that in C2 dome-like expansive laminoplasty group, while the postoperative pain was more obvious. There was no significant difference in postoperative neurological recovery between the two groups. Using C2 dome-like expansive laminoplasty could reduce postoperative axial pain than the C2 expansive open-door laminoplasty surgery. For patients withossified tissue in the spinal canal, which occupies more than 50% of the sagittal diameter of the spinal canal, or with developmental spinal stenosis, C2 expansive open-door laminoplasty may berecommend to get more adequate decompression. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Axis; Decompression, surgical

Treatment of cervical ossification of the posterior longitudinal ligament by modified laminoplasty with C3 laminectomy and C7 spinous process retention

Objective To observe the clinical efficacy of modified laminoplasty with C3 laminectomy and C7 spinous process retention in the treatment of cervical ossification of the posterior longitudinal ligament(OPLL). Methods From Febru-ary 2014 to March 2016, 133 cases of OPLL were admitted, and 42 OPLLs were included according to the inclusion and exclusion criteria. A case-control study was conducted. Twenty-two cases were included in modified group and 20 cases in traditional group. There were 13 males and 9 females in the modified surgery group, and the average age was 56.2±9.75 years (39-77 years).Modi-fied surgery was conducted with C3 laminectomy, C4-C6 laminoplasty, resection at the upper part of the C7 lamina and retaining the C7 spinous process. Meanwhile, there were 12 males and 8 females in the traditional surgery group, with an average age of 53.7±8.23 years (41-75 years). Patients in the traditional surgery group were treated with standard C3-C7 laminoplasty. The mean follow-up was 22.9±4.5 (15-29) months. The JOA, NDI scores of the two groups were recorded preoperatively and postoperatively. The physiological curvature and activity of the cervical spine before and after operation were observed, and the incidence of axonal symptoms and postoperative complications in both groups were recorded. Results The follow-up period was 15-28 months, with an average of (23.2 ± 4.8) months. There was no significant difference between the base line of two groups before operation. At the last follow-up, the JOA and NDI scores of the two groups were significantly improved. There was no difference of JOA scores be-tween the two groups at the last follow-up, while the NDI sores at the modified group(6.56±4.78) was superior to the traditional group(9.25±7.63). The VAS score at the first day after surgery in modified group was lower than that of the traditional group. The average cervical curvature of the patients in the modified surgery group and the standard surgery group were 12.32°±8.26° and 11.56°±8.05°, respectively. There was no significant difference between the two groups. The postoperative range of movement (ROM) of cervical spine was 39.68°±9.52° in modified group and 33.51°±10.39° in traditional group(P<0.05). Eight patients (19%) had augmentation of axial symptoms, including 3 patients in the modified surgery group(13.6%) and 5 patients in the stan-dard surgery group (30%). There was no significant difference between the two groups. During the follow-up period, there were no complications such as cerebrospinal fluid leakage, spinal cord injury, wound infection, laminar collapse, postoperative closure, in-ternal fixation loss or fracture. Conclusion The modified laminectomy with C3 laminectomy and C7 spinous process retentionis minimally invasive, whichachieved satisfactory decompression effect, reduced the incidence of postoperative axial symptoms and maintained the cervical ROM. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Decompression, surgical

The progression of ossification of the posterior longitudinal ligament of the cervical spine: A follow-up study by CT im-aging after laminoplasty

Objective To evaluate the CT imaging after laminoplasty for the patients with ossification of the posterior lon-gitudinal ligament (OPLL) of the cervical spine. Methods From June 2011 to June 2016, Retrospectively analyzed the data of OPLL patients who underwent posterior cervical open-door laminoplasty. There were 21 patients finally enrolled in this study, which consisted of 11 male and 10 female aging from 55-69, mean(61.48±4.29). The preoperative patients all had severe symp-toms of spinal compression. Collected the Japanese Orthopaedic Association Scores(JOA) Scores of all patients for gender, age, pre-operative and postoperative follow-up.The length, width and thickness of OPLL were measured by CT scan and two-dimensional re-construction of cervical spine during preoperative and follow-up, and the average progress rate was calculated. The relationship be-tween OPLL size before surgery and OPLL progress rate after surgery was analyzed. Results A total of 21 patients were included in this study, with an average age of 61.48±4.29 years-old. The mean follow-up time was 3.36±1.92 years. The JOA score of cervi-cal spine was 11.81±1.75 before operationand 14.43±1.69 at the last follow-up time (t=3.8, P<0.01). The progression rate of OPLL length, width and thickness was 3.54± 2.89 mm/year, 0.49± 0.52 mm/year and 0.34± 0.21 mm/year, respectively. Compared with the width and thickness, the average progress speed of the length was statistically significant (t=3.6, P=0.003; t= 3.8, P=0.002). The progression rate of the rostraland caudal of OPLL was 1.54 ±1.19 mm/year and 1.60±1.33 mm/year (t=0.1, P=0.559). Linear regression showed that OPLL length progression speed (mm)=0.05×preoperative length+1.23, R2=0.26 and P=0.02. Theprogres-sion rate of width and thickness of OPLL had no correlation with preoperative OPLL width and thickness. The progression rates of local, segmental, continuous, and mixed OPLL were 3.02±0.26 mm, 2.97±0.65 mm, 3.65±1.14 mm, and 3.82±1.27 mm per year. Conclusion The JOA score of the posterior open-door laminoplasty of the cervical OPLL patients was significantly improved dur-ing a short-term follow up. CT imaging follow-up showed there was progression of OPLL in length, width and thickness, and the progression rate of length was faster than width and thickness. However, there was no significant difference between the progres-sion of rostral and caudal of OPLL. In addition, short-term follow-up showed a positive correlation between the progression rate of OPLL length and the length of OPLL preoperation.The progress rate of mixed and continuous OPLL may be greater than that of seg-mental and limited OPLL. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Tomography, spiral computed; Follow-up studies

Risk factors for axial symptoms after posterior cervical double door laminoplasty

Objective To explore and analyze the risk factors of axial symptoms after posterior cervical laminoplasty. Methods Retrospectively follow up the patients taking posterior cervical laminoplasty in Jishuitan Hospital during May 2005 to July 2011, due to multi-segmental cervical stenosis or (and) cervical ossification of posterior longitudinal ligament. All patients' gender, diagnosis, age, preoperative neck and shoulder pain, VAS score, course of disease, presence or absence of root symptoms, medical complications, operation time, operation method, blood loss, postoperative neck support time, presence or absence of C5 nerve root paralysis, preoperative JOA and postoperative best JOA, preoperative C2-C7 Cobb angle in neutral position, flexion position, post-extension and calculate the activity were collected. Record the process of axial symptoms in details and statistically analysis by SPSS. Results All of 146 patients were followed up for 58-134 months with an average of 89.5±18.4 months. There were 57 cases of axial symptoms, the overall incidence was 39.0%; except for 7 cases with symptom relief in 6 months, the other 50 cases (34.25% of the total number of follow-up) of the axial symptoms continued by the time of follow-up. 35 patients (23.97%) were characterized by stiffness and 22 patients (18.49%) showed pain, traction and tightness. 36 patients (24.66%) showed axial symptoms on the shoulder and back, 10 (6.85%) appeared around the wound and 11 (7.53%) appeared on both the shoulder and the wound. Univariate logistic regression analysis showed that intraoperative blood loss (P= 0.019, odds ratio(OR) 1.857, 95% CI 1.107-3.116) and postoperative best JOA score (P= 0.008, OR=0.780, 95% CI: 0.650-0.936) significantly affected the occurrence of postoperative axial symptoms. Multifactor Logistic regression analysis was carried out by stepwise forward method. It was found that besides the intraoperative blood loss and postoperative best JOA score, the following factors also affected the incidence of axial symptoms after operation (P<0.05): diagnosis, preoperative age, the extension of C2-C7 Cobb angle before operation, and the operation destruction of C7 spinous process muscle stops. The diagnosis of ossification of the posterior longitudinal ligament, preoperative age, and the extension of C2-C7 Cobb angle before operation were the protective factors for the axial symptoms, and the diagnosis of multiple segments of the cervical spinal stenosis and the operation destruction of C7 spinous process were the risk factors for the axial symptoms after the operation. Conclusion Younger, less preoperative C2-C7 Cobb extension, the operation destroys the C7 spinous process muscle stop point, more intraoperative blood loss, lower postoperative best JOA score and patients with multi-segment cervical stenosis more are more easily to have axial symptoms after posterior cervical double door laminoplasty. Key words: Cervical vertebrae; Spinal stenosis; Ossification of posterior longitudinal ligament; Postoperative complications; Risk factors

Thoracic vertebral synostosis & its clinical importance

Background: Thoracic vertebral synostosis is of interest not only to the anatomist but also to surgeons, neurologist, orthopedician, radiologist, anaesthetics and for forensic medicine also. Various vertebral anomalies have been reported by different authors such as Sacralisation, Lumbarisation, Occipitalisation, absence of posterior elements of vertebral arch and vertebral synostosis. Methods: The present study was conducted on 408 dry adult human vertebrae of unknown age & sex obtained from the Department of Anatomy, All India Institute of Medical Sciences, Phulwari-Sharif, Patna. Result: According to our study, we found presence of one set of fused 4th and 5 th thoracic vertebrae (2.94%), one set of 5 th to 8 th thoracic vertebrae (2.94%). Out of 34 sets of vertebral columns we got 2 sets of fused thoracic vertebrae 5.88%. 2 sets of fused thoracic vertebrae presents ossification of the anterior longitudinal ligament. Conclusions: Knowledge about any deviation from the normal anatomy of vertebral column can lead to major or minor complications affecting the different system of the body. This study is also clinically important as they might be associated with genitourinary, neurological and musculoskeletal abnormalities.

Improvement of Walking Ability Using Hybrid Assistive Limb Training in a Patient with Severe Thoracic Myelopathy caused by Ossification of the Posterior Longitudinal Ligament - A Case Report

The purpose of this study was to report the improvement of walking ability using Hybrid Assistive Limb (HAL) training in a case of severe thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). The patient received HAL training 2-3 times per week (10 sessions) beginning on the thirteenth postoperative day. The patient’s walking ability and lower muscles strength were significantly improved. It suggests that HAL training in the early postoperative phase has the potential to be an effective rehabilitation tool to improve functional ambulation in surgically-treated thoracic OPLL patients with inability of walk.

Cervical Myelopathy Secondary to Combined Ossification of Ligamentum Flavum and Posterior Longitudinal Ligament

Cervical Myelopathy Secondary to Combined Ossification of Ligamentum Flavum and Posterior Longitudinal Ligament

Surgical Outcomes of the Ossification of the Posterior Longitudinal Ligament According to the Involvement of the C2 Segment

The complex structure around the upper cervical spine makes surgical treatment difficult. the present study aimed to analyze how patients with ossification of the longitudinal ligament (OPLL) involving the C2 were managed and to compare the surgical outcomes according to the C2 involvement. Ninety-five patients with cervical OPLL who underwent surgical treatment were divided into C2 involvement (C2+ group, 40 patients) or none (C2- group, 55 patients). In the C2+ group, subanalysis was conducted to according to the C2 surgery (C2 surgery+ group, 14 patients). All patients had a minimum of 1 year of follow-up with a mean of 51.36 months. The most common location of the narrowest space available for the spinal cord was C2 and C5 in the C2+ and C2- groups, respectively. In the C2+ group, a longer OPLL with thickened diameter was radiographically demonstrated, but clinical outcomes were not different from the C2- group. In the C2 surgery+ group, the narrowest spinal cord was common in the C2 (50.0%), and an extension of the signal change of spinal cord to the C2 was observed in 4 patients, showing a statistical difference. C2 surgery was performed in all patients using the posterior approach and it did not result in different clinical outcomes or surgery-related complications. An anterior surgical approach was deemed risky given the chance of the development of complications. Both of C2 involvement from OPLL and surgery including the C2 did not affect clinical outcomes. The posterior decompressive surgery is safer and more effective than the anterior approach regarding the development of surgery-related complications.

An unusual cause of dysphagia

A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine (Fig. 1) revealed diffuse ossification of the anterior longitudinal ligament (straight line, Fig. 1). This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level (dashed line, Fig. 1) and there was severe narrowing of the airway (Fig. 1, arrows). He was diagnosed as Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's disease, which is characterized by ossification of longitudinal ligaments (esp. anterior longitudinal ligament) (Fig. 2, arrows) along with sparing of sacroiliac joints (Fig. 3, arrows). It usually affects males aged greater than 50 years and is usually an incidental radiological finding and only symptomatic lesions need specific treatment. This patient was advised diet modification and surgical removal of the ossified mass if the dysphagia persisted. The most common differential of the DISH is Ankylosing Spondylitis (AS). These two entities can be differentiated on the basis of age at presentation and the involvement of a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x

Analysis of Musculoskeletal Systems and Their Diseases. Genomic medicine of bone and joint diseases : present and future

Susceptibility genes for various kinds of common diseases have been identified by the genome-wide association study (GWAS) and the outcome is changing the clinical medicine significantly. Musculoskeletal disease is no exception. In this paper, I review the current status and prospect of GWAS in musculoskeletal diseases in Japan by focusing on representative common musculoskeletal diseases : disc herniation, adolescent idiopathic scoliosis and ossification of the posterior longitudinal ligament of the spine.

Preexisting severe cervical spinal cord compression is a significant risk factor for severe paralysis development in patients with traumatic cervical spinal cord injury without bone injury: a retrospective cohort study.

The objective of this study is to investigate whether preexisting severe cervical spinal cord compression affects the severity of paralysis once patients develop traumatic cervical spinal cord injury (CSCI) without bone injury. We retrospectively investigated 122 consecutive patients with traumatic CSCI without bone injury. The severity of paralysis on admission was assessed by the American Spinal Injury Association impairment scale (AIS). The degree of preexisting cervical spinal cord compression was evaluated by the maximum spinal cord compression (MSCC) and was divided into three categories: minor compression (MSCC ≤ 20 %), moderate compression (20 % < MSCC ≤ 40 %), and severe compression (40 % < MSCC). We investigated soft-tissue damage on magnetic resonance imaging to estimate the external force applied. Other potential risk factors, including age, sex, fused vertebra, and ossification of longitudinal ligament, were also reviewed. A multivariate logistic regression analysis was performed to investigate the risk factors for developing severe paralysis (AIS A-C) on admission. Our study included 103 males and 19 females with mean age of 65 years. Sixty-one patients showed severe paralysis (AIS A-C) on admission. The average MSCC was 22 %. Moderate compression was observed in 41, and severe in 20. Soft-tissue damage was observed in 91. A multivariate analysis showed that severe cervical spinal cord compression significantly affected the severity of paralysis at the time of injury, whereas both mild and moderate compression did not affect it. Soft-tissue damage was also significantly associated with severe paralysis on admission. Preexisting severe cervical cord compression is an independent risk factor for severe paralysis once patients develop traumatic CSCI without bone injury.

Cervical Spine CT and MRI Findings in a Patient with Ossification of the Posterior Longitudinal Ligament

Received August 15, 2014 Revised October 1, 2014 Accepted October 1, 2014 Address for correspondence: Dong Kuck Lee, MD Department of Neurology, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea Tel : +82-53-650-4267 Fax : +82-53-654-9786 E-mail : dklee@cu.ac.kr 61세 남자가 수년간의 경부통증 및 어깨관절 근력약화로 내 원하였다. 생체징후는 정상이며 특이한 과거력은 없었다. 신경 학적진찰에서 우측 어깨 굽힘 및 바깥회전시 근력저하(MRC grade 3)가 있었으나 감각이상 및 근위축은 없었다. 우측 어깨 관절의 수동운동 제한은 없었다. 양측 상하지의 심부건 반사는 정상이었으며 Hoffmann징후는 보이지 않았다. 자기공명영상에

Association of bone morphogenetic protein-2 gene polymorphisms with susceptibility to ossification of the posterior longitudinal ligament of the cervical spine in Chinese patients

Objective To investigate the association of single nucleotide polymorphism (SNPs) of bone morphogenetic protein-2 (BMP-2) gene encoding region with susceptibility to ossification of the posterior longitudinal ligament (OPLL) of cervical spine and its severity in Chinese patients.Methods A total of 420 OPLL patients and 506 age-and sex-matched controls were studied.Genomic DNA was isolated from venous blood and polymerase chain reaction (PCR) was performed with a standerd protocol.The PCR products were analyzed by direct sequencing.To compare the genotypic and allelic distribution between OPLL cases and control subjects.Results The number of subjects in the total study population with the Ser37Ala (T/G)TT,TG and GG genotypes was 752,174 and 0,respectively,with frequencies of 81％,19％ and 0,respectively.There was a statistical difference between OPLL cases and control subjects (P ＜ 0.001),The TG genotype was associated with the occurrence of OPLL.The number of subjects in the total study population with the Arg190Ser (A/T) AA,AT and TT genotypes was 228,464 and 234,respectively,with frequencies of 24％,50％ and 26％,respectively.There was a statistical difference between OPLL cases and control subjects (P ＜ 0.01),The AT genotype was associated with the occurrence of OPLL.For the Ser87Ser (A/G) polymorphism,patients with G allele had a significantly greater number of ossified vertebrae compared with patients without A allele.Condusion The Ser37Ala (T/G) polymorphism in exon2 and the Arg190Ser (A/T) polymorphism in exon3 of BMP-2 gene are associated with the occurrence of OPLL.The Ser87Ser (A/G) polymorphism in exon2 of BMP-2 gene is associated with more extensive OPLL.BMP-2 gene is the susceptibility gene of OPLL. Key words: Ossification of posterior longitudinal ligament; Bone morphogenetic protein-2; Single nucleotide polymorphisms

Managing Spondylotic Cervical Myeloradiculopathy Using Oblique Cervical Corpectomy

IntroductionThe technique of oblique cervical corpectomy describes preservation of significant portion of the anterior and lateral aspects of the vertebral body.1 In 1999, Ozer et al described a te...