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PubMed1988

Ossification of the ligamentum flavum. A case report and its MRI finding.

A case of thoracic myelopathy due to ossification of the ligamentum flavum is presented. A fifty-five year old female complained of sensory and motor disturbance of lower limbs. Neuroradiologically, in addition to ossification of the posterior longitudinal ligament throughout the spines, ossified ligamenta flava were found at the Th10-11 level and magnetic resonance imaging (MRI) clearly showed the spinal cord compressed at the same level by a low-intensity-signal lesion. Laminectomy and removal of the ossfied ligamenta flava improved her neurological dysfunction. The usefulness of the MRI in the neuroradiological diagnosis was confirmed.

Female↗

PubMed1985

Retinoid-induced ossification of the posterior longitudinal ligament.

Vitamin A and its synthetic congeners are known to produce a variety of skeletal abnormalities in patients on prolonged treatment with these medications. Two patients are described who developed posterior longitudinal ligament ossification following treatment with the synthetic retinoid 13-cis-retinoic acid. In both cases, this finding became apparent after other retinoid-induced skeletal abnormalities were observed and was less marked than the ossification of the anterior longitudinal ligament. Although spinal cord compression did not occur in our patients, patients on long-term retinoid therapy should be carefully observed for this complication.

Adolescent↗

PubMed1990

Total decompression of the spinal cord for combined ossification of posterior longitudinal ligament and yellow ligament in the thoracic spine.

One of the causes of hyperostosis in the spinal canal, ossification of the posterior longitudinal ligament (OPLL) combined with ossification of the yellow ligament (OYL) in the thoracic spine, can result in serious myelopathy, leading to sandwich-type compression of the spinal cord from anterior and posterior. For such cases we devised a treatment of total decompression of the spinal cord and intervertebral body fusion. This operation consists of two steps. The first step is designed for posterior and lateral decompression of the spinal cord by removal of the OYL following wide laminectomy. The second step is removal of the OPLL anteriorly for anterior decompression, followed by interbody fusion. As the final procedure of the first step, two deep parallel gutters, covering the extent of the OPLL to be removed anteriorly, are drilled down from the rear into the vertebral body along both sides of the dura. This pre-treatment makes removal of the OPLL anteriorly during the second stage much easier, faster, and safer. This operation is lengthy and demanding. However, based on our experience so far, it appears to be a promising surgical procedure.

Adult↗

PubMed1995

Prevention of heterotopic ossification in hip arthroplasties by means of an early single-dose radiotherapy (6 Gy).

Radiotherapy has proven to be efficient in the prevention of heterotopic bone formation. Its importance is increasing in the treatment of uncemented implants in prosthetic hip surgery, where a localized irradiation field is applied to cover the bone-implant interface. In a prospective study the efficiency of two radiation concepts using two different doses to prevent heterotopic ossifications after total hip arthroplasties or revision arthroplasties was compared. In 7 patients after fractioned irradiation (5 x 2 Gy), two recurrences of periarticular ossification occurred, whilst in 17 patients after a single-shot irradiation of 6 Gy on the first postoperative day, no recurrences were seen. There were no side-effects from the radiation. Radiological signs of lucent cement-free implants or delayed wound-healing were absent. Thus, a single shot of 6 Gy applied within 24 h postoperatively reliably prevents heterotopic bone formation. It is safer than 5 x 2 Gy and facilitates the management of the patient.

Aged↗

PubMed1985

Massive heterotopic ossification in breast implant capsules.

A patient is presented with massive heterotopic ossification of breast implant capsules, 17 years after surgical implantation of Silastic prostheses. The patient has been receiving oral calcium supplements for the past 3 years. This condition developed diffusely throughout the breast capsules. The capsules were 1.2 to 2.2 cm thick and demonstrated a layered structure. The calcified material was demonstrated radiologically and histologically to be true ossification.

Breast↗

PubMed1975

[Heterotopic ossification in cancer of the stomach. An experimental contribution to a clinical phenomenon (author's transl)].

Heterotopic ossifications are found frequently in rats with nitrosoguanidine-induced carcinomas of the gastric stump. The following steps of differentiation of the desmal ossification in the stump carcinomas are demonstrated: 1. Osteoblasts. 2. Osteoid. 3. Woven Bone reticular network. 4. Lamellar bone. The islands of metaplastic bone cells are predominantly located in the invasive marginal area of the carcinoma of the gastric stump. The histology is similar to that one seen in stomach cancer of men. Therefore, the here described model seems to be suitable for further study of the metaplastic bone formation in the gastrointestinal tract.

Animals↗

PubMed2005

The influence of heterotopic ossification on functional status of hip joint following total hip arthroplasty.

PURPOSE: The functional failure induced by heterotopic ossification (HO) following total hip arthroplasty (THA) was analyzed and correlated to the radiologic failure. PATIENTS AND METHODS: From July 1997 to July 2001, 315 patients (345 hips) received THA indicated by a hypertrophic osteoarthritis of higher degree (Kellgren grade III, IV). All patients were irradiated prophylactically for prevention of HO on the evening before surgery with a 7-Gy single fraction. The patients' median age was 66.3 years. Radiologic failure was assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). Analysis of radiographs was performed according to the Brooker Score. Clinical failure was appraised by measurement of passive range of motion (ROM) of the hip joint with a standard goniometer. The t-test was used for statistical analysis. RESULTS: 281 patients (81.5%) did not develop HO. HO of Brooker grade I or II was found in 58 patients (16.8%). Six patients (1.7%) developed HO Brooker grade III or IV. There was a significant negative correlation between the degree of radiologic and clinical failure. ROM differed significantly between patients with HO Brooker grade 0, I, II and patients with HO Brooker grade III, IV. Comparing the pre- and postoperative ROM, all patients with Brooker grade 0, I and II showed a significant improvement of flexion, internal and external rotation, abduction and adduction movement. Patients with HO Brooker grade III and IV showed no improvement of ROM in the postoperative follow-up. CONCLUSION: The development of HO following THA influences the physical function of the hip joint dependent on the degree of ossification. HO of lower degree (Brooker I, II) does not influence the clinical outcome, whereas HO of higher degree (Brooker III, IV) reduces the function of hip arthroplasty. Therefore, the purpose of a prophylactic therapy must be to reduce HO of higher degree.

Aged↗

PubMed1997

[Heterotopic ossifications of 5 large body joints after 105 days of intensive care with 72 days of artificial ventilation].

A 37-year-old woman had intensive care for 105 days and artificial ventilation for 72 days because of a lung transplantation and multiple postoperative complications. She developed severe heterotopic ossification of both shoulders, the right elbow and both hip joints. Owing to complete joint stiffness, she was immobilized and unable to eat or drink without help. Operative treatment was performed in two procedures. The right shoulder and right elbow were operated on first; the right hip and later the left hip were operated on after recovery from the previous surgical procedures. After 22 months, there was a good functional result; the patient took part in all activities of daily life and was pain-free. The present knowledge on heterotopic ossifications is summarized, as well as possible prophylactic measurements.

Adult↗

PubMed2002

Osteochondrosis of the primary ossification center of the patella (Köhler's disease of the patella) report of three cases.

Radiography of three boys 5-6 years old with anterior knee pain revealed increased density and irregularity of the patellar ossification centers. A search of the literature suggested that it was osteochondrosis of the primary ossification center of the patella, named after Köhler. Continuing search also revealed that it might be a normal variant instead of an osteochondrosis. A short course of activity modification led to marked improvement in all. The patients were either asymptomatic or experienced minor symptoms 18-34 months after presentation. It was concluded that the process, either physiological or pathological, has a benign course and favorable prognosis.

Child↗

PubMed1998

Involvement of insulin-like growth factor I in development of ossification of the posterior longitudinal ligament of the spine.

In order to investigate the pathogenesis of ossification of the posterior longitudinal ligament (OPLL) of the spine, we examined the distribution of insulin-like growth factor I (IGF-I) in the posterior longitudinal ligaments of OPLL patients, and analyzed the effects of IGF-I on the cultured spinal ligament cells. For that purpose we established eight varieties of OPLL and non-OPLL cell lines obtained from spinal ligaments of corresponding patients, respectively. In contrast to non-OPLL cases, all the OPLL cases were histologically shown to contain round-shaped cartilage-like cells in the transitional region from preossifying to ossifying ligaments, and these cells were strongly stained with an antibody for IGF-I. In the vicinity of preossifying cartilaginous tissues, ligament cells also had a rod-like appearance and were positive for IGF-I immunohistochemically. The effects of IGF-I on cultured spinal ligament cells were assayed by alkaline phosphatase (AP) activity, DNA synthesis, and the amounts of collagen produced. The number of OPLL cell lines that increased AP activity, responding to IGF-I irrespective of 1,25(OH)2D3, was significantly larger than that of non-OPLL cell lines, although IGF-I stimulated DNA and procollagen type I carboxyl-terminal peptide synthesis in most of both OPLL and non-OPLL cell lines. These data demonstrate the dominant expression of IGF-I in the posterior longitudinal ligaments of OPLL patients, and suggest that IGF-I preferentially induces osteogenic differentiation in OPLL cells rather than in non-OPLL cells. IGF-I, therefore, may be involved in the local ossification process of spinal ligaments observed in OPLL patients.

Adult↗

PubMed2005

Inter-observer reliability in the assessment of heterotopic ossification: proposal of a combined classification.

We applied four published classifications for assessment of heterotopic ossification after total hip arthroplasty (Arcq, Brooker, DeLee and Della Valle [1, 2, 5, 6]. The average incidence of heterotopic ossification varied from 19.8% to 27.7%. The inter-observer reliability of the various classifications was determined by Cohen's Kappa statistic. Kappa values ranged from 0.897 for Arcq's to 0.814 for Brooker's classification. In order to increase the reliability and consistency, we propose a new classification system combining Brooker's and Della Valle's classifications. This new classification preserves the high reliability of Della Valle's system and is comparable to previous publications since it includes Brooker's criteria.

Aged↗

PubMed2006

Prevention of heterotopic ossification in high-risk patients with total hip arthroplasty: the experience of a combined therapeutic protocol.

The combination of radiotherapy and indomethacin for the prevention of heterotopic ossification (HO) in high-risk patients undergoing total hip arthroplasty (THA) has not been reported. The aim of the present study was to present the experience of our department with this combined therapeutic protocol. Fifty-four patients who underwent THA received a single dose of 7 Gy of postoperative radiotherapy and 75 mg of indomethacin for 15 days. Patients were analyzed for clinical and radiographical evidence of HO development at 1 year postoperatively. The overall radiographical incidence of HO was 20.4% (95% CI 10.6-33.5%), while only 1 patient with clinically significant HO was seen. Patients with secondary arthritis due to congenital hip disease had a statistically significantly higher incidence of HO compared with those with osteoarthrosis. The clinical assessment with the Merle d'Aubigné score showed that patients with radiographic documentation of HO had a lower mean score compared with those with no evidence of HO. No treatment-related side effects were seen. Combined radiotherapy and indomethacin was effective in preventing heterotopic ossification after total hip arthroplasty. The evaluation of this efficacy compared with radiotherapy or NSAIDs alone should be the future target of larger randomized designs.

Adult↗

PubMed1999

Prevention of heterotopic ossification in hip arthroplasty. The influence of the duration of treatment.

A retrospective study has been carried out to assess the effectiveness of indomethacin in preventing heterotopic ossification after total hip arthroplasty, and the effect of using it for different periods of time. One hundred and sixty-eight hips operated on in 1983 were not given indomethacin and acted as a control. One hundred and fifty hips operated on in 1988 were given indomethacin and divided into 3 groups: 42 received indomethacin for 5 days, 49 for 11 days and 59 for 45 days. The results indicate that ossification is significantly reduced in those patients receiving indomethacin for 5 and 11 days, but there was no additional reduction when it was given for 45 days. Treatment should begin on the night of operation and continued for 11 days while the patient remains in hospital.

Aged↗

PubMed2001

Preoperative, single-fraction irradiation for prophylaxis of heterotopic ossification after total hip arthroplasty.

We gave a single fraction of 750 cGy preoperatively (within 16 h of surgery) to 143 patients prior to total hip arthroplasty. The patients were evaluated for heterotopic ossification at 1, 3 and 6 months. The preoperative radiation did not affect the surgical procedure. After a median follow-up of 12 (6-24) months we encountered six patients with heterotopic ossifications of Brooker grade I-II. Potential late risks from ionising radiation should be considered when treating younger patients.

Adult↗

PubMed2000

Bilateral styloid chain ossification: case report.

The styloid chain is defined as the styloid process of the temporal bone, the stylohyoid ligament and the lesser cornua of the hyoid bone. Unusually long, incidental bilateral styloid chain ossification is described. This paper is presented for its unusual incidence, unusual length, the presence of ossification rather than calcification and its embryological correlation. Brief mention is made on the embryology and clinical significance of this condition.

Humans↗

PubMed2003

[Diffuse pulmonary ossifications with mortal consequences. A case report].

Dendriform pulmonary ossification (DPO) represents a relatively frequent form of diffuse pulmonary and mostly clinically inapparent bone formation of unknown etiology. An association with other pulmonary diseases, particularly pulmonary interstitial fibrosis, has been suggested. Here we report a female patient with a 15-year history of DPO whereby at the age of 48 an X-ray of the thorax first revealed findings suggestive of pulmonary fibrosis. For 9 years the patient suffered from chronic progressive ventilation disorder and after a further 3 years open lung biopsy revealed DPO in conjunction with interstitial fibrosis. After a history of progressive respiratory failure the patient suddenly died of cardiac arrhythmia along with deteriorated cor pulmonale at the age of 71. Autopsy revealed an almost complete ossification of the lungs with an increasing gradient from apex to base. In contrast to previous reports, the DPO of our patient was life-limiting.

Aged↗

PubMed2005

Heterotropic mesenteric ossification: a case report (2004:10b).

Heterotropic mesenteric ossification is a rare entity. Only a few cases have been described in the literature. We report a case of heterotropic mesenteric ossification in a patient who underwent several laparotomies, after suffering from multiple gunshot wounds. We discuss the radiographic findings of this disease that can easily be misdiagnosed, and review the literature.

Adult↗

PubMed2002

Chronic epidural hematoma with rapid ossification.

CASE REPORT: The authors present a rare case of ossified chronic epidural hematoma. A 13-year-old female patient presented with an ossified chronic epidural hematoma. She had sustained a head injury about 10 weeks previously and had received conservative care for a delayed-onset epidural hematoma at a local hospital. Ossification was identified about 4 weeks after the head injury and then progressed rapidly. A chronic epidural hematoma with a thick collagenous capsule and newly formed bone was removed 73 days after the head injury. CONCLUSION: An epidural hematoma with mild symptoms can be treated conservatively. When, however, the hematoma is observed not to be naturally absorbed during serial follow-up examinations, surgical removal must be considered, even if the patient's condition is good, because this entity carries the risk of bone calcification and ossification.

Adolescent↗