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[Neuroimaging and pathology of the spinal cord in compressive cervical myelopathy].

Magnetic resonance imaging (MRI) has enabled us to see the spinal intramedullary pathology as differences in signal intensity. Intramedullary high intensity lesions were observed on T2-weighted MRI in patients with cervical spondylotic myelopathy (20.0%) and ossification of the posterior longitudinal ligament (OPLL) of the cervical spine (25.7%). The frequency of this findings was proportional to the clinical severity of myelopathy and degree of spinal cord compression. The pathophysiological basis of such signal abnormality was presumed to vary from acute edema to chronic myelomalacia. The intramedullary lesion on MRI is considered to be the main site of lesion responsible for the neurological symptom because of a good correlation between the neurological level and high intensity level. We found from nine autopsy cases of OPLL that there are distinct differences in severity and extent of pathological changes between the spinal cord with a boomerang-shaped cross-section and that with a triangular-shaped cross-section. In the boomerang-shaped cases, major pathological changes were restricted to the gray matter and the white matter was relatively well preserved. Secondary wallerian degeneration was restricted to the fasciclus cuneatus the fibers of which were derived from the affected segments. In the cases of a triangular shape, pathological changes were more severe, both white and gray matter were involved. There were severe pathological changes over more than one segment, and both descending degeneration of the lateral pyramidal tracts and ascending degeneration of the posterior column, including the fasciclus gracilis, were observed. In conclusion, it is clinically very important to understand the pathological basis of the compressed spinal cord on neuroimages.

Cervical Vertebrae↗

[Ossification in corpus cavernosum and review of the literature].

Contribution of one study case of corpus cavernosum ossification including a literature review and analysis of signs and symptoms as well as the potential therapeutic options in that condition. The conversion of the albuginea's connective tissue into bone is the pathological end of La Peyronie's disease.

Humans↗

Spinal cord injury rehabilitation. 2. Medical complications.

This self-directed learning module highlights new advances in understanding medical complications of spinal cord injury through the lifespan. It is part of the chapter on spinal cord injury rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article covers reasons for transferring patients to specialized spinal cord injury centers once they have been stabilized, and the management of common medical problems, including fever, autonomic dysreflexia, urinary tract infection, acute and chronic abdominal complications, deep vein thrombosis, pulmonary complications, and heterotopic ossification. Formulation of an educational program for prevention of late complications is also discussed, including late renal complications, syringomyelia, myelomalacia, burns, pathologic fractures, pressure ulcers, and cardiovascular disease. New advances covered in this section include new information on old problems, and a discussion of exercise tolerance in persons with tetraplegia, the pathophysiology of late neurologic deterioration after spinal cord injury, and a view of the care of these patients across the lifespan.

Adolescent↗

Endometrial ossification and infertility: the diagnostic value of different imaging techniques.

We present a case of longstanding secondary subfertility caused by endometrial ossification. Of all diagnostic techniques performed, magnetic resonance imaging and hysterosalpingography did not detect the abnormality. Transvaginal ultrasound and computed tomography clearly showed the endometrial pathology. After successful operative hysteroscopy with removal of the osseous tissue, the patient became pregnant spontaneously within 2 months.

Adult↗

A radiographic study of variations of the human fetal spine.

Variations of the vertebral column were considered to be those deviations from the norm which were still compatible with normal life and not pathological. The incidence of these variations is described as seen radiographically in a group of normal human fetuses. Ossification centers for the costal processes of cervical vertebra 7 were found to be common (19%), being present in approximately one-fifth of the total number of fetuses studied. They were mostly present as bilateral centers (15%), but because of the cross-sectional nature of the study, it could not be determined whether these centers would have developed into actual cervical ribs. Far less common were the presence of lumbar ribs (1%). Ossification of the vertebral centra was found to be confusing with no clearly defined pattern being evident. In particular, there was a suggestion that some of the vertebral centra might well develop at least initially from bilateral centers. There was also evidence that the vertebral body was the product of four centers and this was supported by other literature. No variations were found which suggested that the vertebra develops from two somite levels, and this appears to be in conflict with the commonly accepted resegmentation theory.

Fetus↗

Radiographic abnormalities in eyes with retinoblastoma and other disorders.

The importance of radiographic examinations of pathological ocular material is stressed. Characteristic ocular radiodensities are observed with retinoblastomas, calcified cataracts, senile scleral plaques, intraocular ossification, and a variety of radiodense foreign bodies. Radiographs supplement other techniques for the documentation of ocular abnormalities and in certain instances may be the ideal method. They also permit the precise localisation of radiodense foreign bodies that need to be removed prior to the processing of tissue for microscopic examination. In certain situations valuable data can be obtained by x-ray examinations of embedded material. Retinoblastomas have an extremely high incidence of radiodensities with a characteristics appearance. This finding stresses the clinical importance of utilising and developing clinically applicable techniques for the detection of calcification in patients with suspected retinoblastomas.

Calcinosis↗

Tibial dyschondroplasia (osteochondrosis) in the turkey. A morphologic investigation.

Sixty-seven Broadbreasted White Turkeys, 4 to 137 days old, were included in the investigation. Some were normal, while others were limping, and some had bowed legs. Immediately after destruction of the birds, the arteries of the legs were injected with Colorpaque, using a technique introduced by the author. The proximal part of one or both tibiae were examined radiographically, macroscopically, and microscopically. The microscopic examination included histology, microangiography, and microradiography. The normal development and morphology of the proximal tibia is presented. Thereafter an account is given of development and morphology of the tibia with dyschondroplastic lesions (retained cartilages). It was found that 39 of the 67 birds had some degree of tibial dyschondroplasia. The retained cartilage was seen in the posteromedial part of the proximal tibial metaphysis. The growth plate both of the normal and abnormal birds consisted of 3 layers of cells in order from the epiphysis--the one of proliferating cells, the one of transitional cells, and the one of hypertrophied cells. A main feature in tibial dyschondroplasia is accumulation of transitional cells, which do not have a vascular supply. By microangiographic means it was possible to demonstrate that the retained cartilage is surrounded by numerous vessels, which apparently cannot get into the cartilage. The reason for the loss of normal differentiation of the cartilage cells and concomitant disturbance of the endochondral ossification is obscure. It is speculated that changes on an ultrastructural and biochemical level are responsible for the pathologic condition. When the retained cartilage reaches a certain size, degenerative changes, necrosis, and fissures occur. Complete healing of the lesion was not seen in any of the birds, but partial disappearance of the proximal or distal part of the retained cartilage took place in some birds. It was concluded that the present investigation has shed light on the development and morphology of tibial dyschondroplasia, but it has also brought forward a number of questions about etiology. There seems to be good reason to believe that dyschondroplasia in the turkey is of similar nature as dyschondroplasia in broilers and osteochondrosis in domestic mammals.

Animals↗

Nonarticular complication of heterotopic ossification: a clinical review.

Heterotopic ossification (HO) is a complication in neurologic lesions such as head injury and spinal cord injury. Limitation of range of motion and ankylosis as results of HO are well documented. In this report, ten instances of nonarticular complications after development of HO are described. There were three instances of vascular compression, five instances of ulnar nerve compression at the elbow, and two instances of suspected lymphedema. Clinical findings and radiographic evidence of these complications are described. Clinicians should be aware of these complications when HO is diagnosed. In addition, HO should be considered in the differential diagnosis of deep venous thrombosis in spinal cord injured and head injured patients.

Adolescent↗

Posterior ossification of the shoulder: the Bennett lesion. Etiology, diagnosis, and treatment.

We report a series of ossific lesions of the posterior inferior glenoid in a group of elite baseball players. We hope to clarify the etiology, diagnosis, and treatment of the Bennett lesion. From August 1985 to August 1991, we identified six professional baseball pitchers and one college pitcher with evidence of ossification of the shoulder on plain radiographs, computed tomography, or magnetic resonance imaging. Arthroscopic examination was performed in all cases. All seven players had identifiable posterior labral injury on arthroscopic examination; six of these seven also had varying degrees of undersurface posterior rotator cuff damage. No anterior tissue damage, anterior instability, or subacromial impingement was noted. No ossification was identified arthroscopically. Intraarticular labral and rotator cuff tears were debrided arthroscopically and patients underwent rehabilitation for 4 to 6 months after surgery. Six of the seven athletes returned to preinjury performance levels; however, one pitcher is no longer playing competitive baseball. The Bennett lesion is an extraarticular posterior ossification associated with posterior labral injury and posterior undersurface rotator cuff damage. It is not, however, a result of traction stresses in the region of the triceps insertion. Recognition is important for identification and treatment of the lesion and associated pathologic damage.

Adolescent↗

A review of the morphology of Perthes' disease.

There are differences of opinion about the pathogenesis of Perthes' disease. All are agreed that it is due to ischaemia, but the cause of this and the size and number of infarctions are in dispute. Through the generosity of the contributors six whole femoral heads and core biopsies of five other cases have been studied radiographically and histologically. The findings ranged from an ischaemic arrest of ossification in the capital articular cartilage without infarction to multiple complete infarctions of the epiphysial bone. The ensuing reparative process contributes to the pathology, which is of a range to warrant grading or grouping.

Cartilage, Articular↗

[Posterior longitudinal ligament ossification: case report].

Posterior longitudinal ligament ossification of cervical spine is a rare condition among caucasians. A 42 years old japanese patient with progressive walking difficulty was diagnosed with this pathology by CT scan and MRI and treated surgically by an anterior approach with arthrodesis. Pathophysiology, racial prevalence, clinical picture, radiological characteristics and surgical approaches options are revised.

Adult↗

[A case of acromegaly associated with variegated spinal disorders].

A case of acromegaly associated with variegated spinal disorders was reported. The spinal disorders were multiple cervical disc herniations, spinal epidural cavernous angioma, multiple ossification of the spinal ligament and lumbar canal stenosis. A 51-year-old woman with acromegaly, complaining of disturbances of delicate hand movement and gate, consulted our department. Her past history included diabetes mellitus, hypertension and progressing enlargement of her extremities. Serum growth hormone level was 65.7 ng/ml and somatomedin-c level was 746 ng/ml. Brain MRI showed a pituitary tumor extending to the right cavernous sinus. Cervical MRI revealed disc herniations at C5/6 and C6/7. Thoracic MRI revealed osteoporosis, ossification of the posterior longitudinal ligament and multiple ossification of yellow ligament. Lumbar MRI disclosed ossification of yellow ligament and canal stenosis. Anterior fusion of C5-C7 and an intracapsular removal of the pituitary tumor were performed. Its pathology was that of eosinophilic adenoma. After 3 months, she suffered from paraparesis. On repeating MRI examination with Gd-DTPA, a spinal epidural mass was found at T4. Under laminectomy of Th3-5 and Th8-11, the epidural mass and ossified yellow ligament were removed. The epidural mass was cavernous angioma. She was able to walk without any assistance. An association of spinal canal stenosis with acromegaly is well known. But the association of disc herniation and with the ossification of spinal ligaments is rather rare in the literature. Spinal epidural cavernous angioma is very rare. We discussed the etiological aspects and the management of spinal disorders with acromegaly.

Acromegaly↗

Ossification of the ligamentum flavum induced by bone morphogenetic protein. An experimental study in mice.

Ossification of the ligamentum flavum and secondary spinal-cord compression were produced experimentally in mice by implanting bone morphogenetic protein (BMP) in the lumbar extradural space. The ligamentum flavum became hypertrophied and ossified, and protruded into the spinal canal. The thickness of the ossified ligament increased gradually with time, leading to compression and deformation of the spinal cord which showed various degrees of degeneration. Demyelination occurred in the posterior and lateral white columns and neuronal loss or chromatolysis in the grey matter. The pathological findings in the experimental animals closely resemble those found in the human disease and suggest that BMP may be a causative factor of ossification of the ligamentum flavum in man. This experimental model may be useful for the study of myelopathy caused by gradual spinal-cord compression.

Animals↗