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PubMed1996

Development of hydrocephalus after cervical laminoplasty for ossification of the posterior longitudinal ligament: case report.

We report a 69-year-old woman who developed serious hydrocephalus after cervical laminoplasty for ossification of the posterior longitudinal ligament. The patient presented with approximately 50% spinal canal compromise pertaining to ossified lesion at C5 and C6 levels and subsequently underwent a C3-C7 open-door laminoplasty, followed by uneventful neurological recovery until 2 weeks postoperatively. Despite a favourable postoperative course, she presented with serious symptoms and signs of intracranial hypertension about 3 weeks after surgery. Computed tomography demonstrated the appearance of marked hydrocephalus, with no explainable cause. A ventriculoperitoneal shunt followed by removal of subdural fluid in the suboccipital fossa resulted in resolution of the clinical symptoms and of the hydrocephalus. It is important to be aware of the very rare occurrence of such intracranial neurological compromise after a cervical laminoplasty operation for long-standing ossification of the posterior longitudinal ligament.

Aged↗
PubMed1997

A rare neurological presentation due to ossification of the posterior longitudinal ligament of the thoracic spine and ankylosing spondylitis: case report.

Ossification of the posterior longitudinal ligament (OPLL) may be associated with certain rheumatic conditions including ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH) or spondylosis. More than 95% of all OPLL are localized at the cervical spine. Herein, we report a case of OPLL at the thoracic spine in an HLA-B27-positive female patient with ankylosing spondylitis. The patient was presented to use with spastic paraparesis. The imaging studies included plain roentgenograms, tomograms, myelo-CT and magnetic resonance imaging (MRI). A continuous rod-like ossification along the posterior aspects of the fourth to sixth thoracic vertebrae with spinal cord compression was noted. The patient underwent a laminectomy from T4 to T6. At the second year follow-up examination, residual upper back soreness and mild left thigh pain were noted. However, the patient had resumed a full daily schedule and could walk freely without any support.

Female↗
PubMed1997

Myelopathy secondary to ossification of the posterior longitudinal ligament of the thoracic spine treated by anterior decompression and bony fusion.

We examined the utility of anterior decompression and bony fusion via the extrapleural approach in the treatment of thoracic myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). Patient outcome and complications were analyzed in 48 patients treated with this procedure, with a follow-up of at least 2 years. The Japanese Orthopaedic Association score was used to evaluate the severity of the thoracic myelopathy, and the recovery rate was used to evaluate the surgical outcome. The outcome, postoperative complications, radiographic evaluations of bony union, and progression of OPLL within the area of anterior decompression were examined. The T3 vertebral body was the highest level to which anterior decompression was applied. The average follow-up period was 57 months with a recovery rate of 56.7% which stabilized 1 year after operation. However, the surgical outcome was less favorable in patients with long-standing myelopathy, extensive OPLL, or thoracic OPLL with coexisting intraspinal ligament ossification. Four patients experienced deterioration of their myelopathy, and seven patients had the postoperative complication of extraspinal leakage of cerebrospinal fluid. The myelopathy was transient in all but one patient. Radiographic studies showed that bony union was achieved and restenosis of the spinal canal due to progression of OPLL within the area of decompression did not occur. We conclude that anterior decompression and bony fusion using the extrapleural approach provides a good outcome and is useful in treating mid- and lower thoracic OPLL when performed carefully at an early stage of disease.

Adult↗
PubMed2006

Ossification of the proximal thoracic ligamenta flava causing acute myelopathy in a Caucasian: case report and literature review.

STUDY DESIGN: Case report and literature review. OBJECTIVE: To illustrate that ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in a Caucasian patient and that timely surgery can lead to a good outcome. SETTING: Nottingham, UK. METHODS: Proximal multiple contiguous ossified thoracic ligamenta flava from T3/T4 to T5/T6 causing acute myelopathy was diagnosed in a Caucasian man based on history and examination followed by magnetic resonance imaging and computed tomography scanning. The literature is reviewed for all reported cases of ossified ligamenta flava causing myelopathy in Caucasians. RESULTS: Following prompt diagnosis and T3 to T5 laminectomies, our patient made near-complete neurological recovery over a 10-month period. This condition usually affects the lower thoracic spine. Although chronic and subacute myelopathy secondary to this circumstance has been reported in Caucasians, acute myelopathy has not been reported and proximal thoracic involvement has been reported twice. CONCLUSION: Ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in Caucasians. Prognosis following decompressive surgery is usually good.

Diagnosis, Differential↗
PubMed2003

Cartilaginous metaplasia in calcified diabetic peripheral vascular disease: morphologic evidence of enchondral ossification.

The mechanism of arterial calcification is not clear. We examined histological sections of major arteries from lower extremities of two patients with longstanding type II (or non-insulin-dependent) diabetes mellitus, and found morphological evidence of cartilaginous metaplasia and ectopic ossification with associated severe medial arterial calcification and atherosclerosis. Hematoxylin and eosin, alcian blue, and toluidine blue stains were applied for the demonstration of cartilage cells and their specific matrix proteins, and immunohistochemical studies for type II collagen. To our knowledge, cartilaginous metaplasia has not previously been described in medium-sized human muscular arteries. This observation supports the hypothesis that active enchondral ossification may be a pathway leading to arterial calcification in diabetic obstructive peripheral vascular disease.

Arteries↗
PubMed1999

Ossification in the rectus sheath following free rectus flap.

Heterotopic ossification (HO) is a rare complication of laparotomy wounds. In this report, we describe an unusual presentation of ossification within the closed sheath following the harvest of a free rectus flap for lower limb reconstruction. Of specific interest to this case is that access to the rectus was gained through a lower transverse approach. Furthermore, the extremities of this incision were utilised for harvest of cancellous bone from the iliac crests. Given that one explanation for HO is intraoperative seeding it is of note that no problem was encountered in the wound intimately associated with the bony disruption.

Adult↗
PubMed2002

Ossification of the ligamentum flavum.

We report the case of a 32-year-old South Korean male who presented with bilateral leg weakness, spastic gait and associated sensory loss from below the T5 dermatome. MRI and CT scans of the spine confirmed the presence of calcified ligamentum flavum from T1-T6. A thoracic laminectomy resulted in an excellent post-operative recovery with full return of all functions. This case review will discuss the differences that exist between ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), but also the similarities at a molecular and possibly at a genetic level. We have reviewed the reported literature of patients presenting with progressive lower limb spacity due to OLF, and an excellent outcome is achieved using decompressive laminectomy.

Adult↗
PubMed2002

Unilateral ossification of the ligamentum flavum in the cervical spine with atypical radiological appearance.

We report a case of symptomatic unilateral ossification of the ligamentum flavum with unusual radiological presentation in the cervical spine. The patient was a 64 year old man with numbness and weakness of the left upper extremity who was admitted to our hospital. Computerized tomography revealed a triangular-shaped high density mass severely compressing the spinal cord at C6. Concomitant small ossification of the posterior longitudinal ligament was noted from C3 to C6. The ossified mass was completely removed via a unilateral osteoplastic laminectomy of the left C6 and C7.

Cervical Vertebrae↗
PubMed1978

[Ossification of the auricle in partial pituitary failure with selective ACTH and STH deficiency (author's transl)].

An acquired partial pituitary insufficiency of unknown origin with selective ACTH and STH deficiency was demonstrated in a 44-year-old patient. The clinical course over many years corresponds to subclinical Addison's disease with occasional acute crises. Ossification of both auricular cartilages and anhidrosis were outstanding signs. There is possibly a connection between the glucocorticoid deficiency over many years with normal mineralocorticoids and the auricular cartilage ossification.

Adrenocorticotropic Hormone↗
PubMed2006

Intra-tendinous ossification with concomitant tendonitis and bursitis--ultrasound grey-scale and colour Doppler findings.

A case report of a 62-year-old man with a 20-year history of tendon problems, who presented with a swollen and tender left Achilles tendon. Ultrasound (US) revealed a 2 x 1 x 0.9 cm intra-tendinous substance with acoustic shadowing. On a radiogram, ossification was found. Colour Doppler activity was present in both the bursa and the tendon. A US-guided injection of 40 mg Depomedrol was applied into the retrocalcaneal bursa. On follow-up two months later, the patient had no symptoms and US showed total regression of Doppler activity. The ossification was unchanged. US colour Doppler may be recommended for guidance and monitoring of treatment.

Bursitis↗
PubMed1992

[Ossification of the stapedius tendon as a rare cause of conductive hearing loss].

Ossification of the stapedial tendon is a very rare cause of conductive hearing loss. In addition to a review of the literature, two further cases of unilateral hearing impairment are reported. In both cases, division of the ossified tendon led to a complete disappearance of the middle-ear problem. Apart from middle ear malformations, infections of the middle ear may also give rise to ossification of the stapedial tendon.

Audiometry, Pure-Tone↗
PubMedDate not supplied

[Prevention of ossification after total hip endoprosthesis with indomethacin and its effect on gastric mucosa].

The administration of indomethacin as a prophylactic against heterotopic ossification following the implantation of total hip-joint endoprosteses entails the risk of gastrointestinal side-effects. A prospective randomized study set out to determine the effectiveness of ranitidine and sucralfate as a secondary treatment for the protection of the stomach. Comparison with a placebo group monitored at the same time confirmed the efficacy of both medicaments. Both ranitidine (2 x 150 mg) and sucralfate (4 x 1 g) were able to prevent the occurrence of ulcers of the mucous membrane of both stomach and duodenum. Thanks to postoperative prophylactic treatment with indomethacin (2 x 50 mg for 3 weeks), there were no serious ossifications (degree II or III according to Arqu).

Adult↗
PubMed1986

[Intraocular ossification in clinically unsuspected malignant melanoma of the uvea and in phthisis bulbi].

Phthisical eyes of 2 patients revealed clinically unsuspected, partially necrotic and partially vital malignant melanomas of the uvea and extensive intraocular ossification. Both eyes had had recurrent intraocular inflammatory episodes for years before they were enucleated because of pain. Intraocular ossification does not rule out the presence of clinically unsuspected malignant melanoma of the uvea.

Aged↗
PubMed2004

No difference between two doses of diclofenac in prophylaxis of heterotopic ossifications after total hip arthroplasty.

BACKGROUND: In a monocentric, randomized, placebo-controlled double-blind study, we investigated the efficacy of two doses of diclofenac-cholestyramine for the prevention of heterotopic ossification (HO). PATIENTS: The study comprised 245 patients undergoing total hip arthroplasty (THA). RESULTS: With 150 mg cholestyramine-bound diclofenac (2 x 1 capsule Voltaren resinate) daily during a postoperative period of 14 days, 19% of patients showed slight HO (Brooker grade 1), and no patient had more severe ossifications (grades 2-4). In the group receiving 75 mg daily (1 x 1 capsule), 17% of patients showed grade 1 HO and 4% grade 2 HO. No patient had grades 3-4 HO. No differences in clinical results were seen between the two groups 6 months after THA. INTERPRETATION: Since the rate of adverse gastrointestinal events was lower (23% versus 38%, p = 0.02) in the group receiving the lower dose, we recommend it.

Aged↗
PubMed1983

Radionuclide assessment of heterotopic ossification in spinal cord injury patients.

Whole body 99Tc-pyrophosphate bone scans were obtained and correlated with skeletal radiographs for detection of heterotopic ossification in 135 spinal injury patients. There were 40 patients with recent injury (less than 6 months) and 95 with injury of over 6 months duration. Heterotopic new bone was detected on the bone scan in 33.7% of 95 patients with spinal cord injuries of more than 6 months duration and 30% of 40 patients with injuries of less than 6 months. The radionuclide scan was found to be useful in detection of heterotopic ossification at its early stage and in its differentiation from other complications in spinal cord injury patients.

Adult↗
PubMed2000

The effect of etidronate on late development of heterotopic ossification after spinal cord injury.

Forty patients with spinal cord injury (SCI) and heterotopic ossification (HO) were treated with etidronate and followed after therapy to determine the effects of long-term medication on heterotopic bone formation. Eighteen patients had tetraplegia and 22 had paraplegia. Early diagnosis of HO (positive bone scintigraphy and negative radiographic findings of HO) was established by 3-phase bone scintigraphy using 99m technetium-labeled methylene diphosphonate. All patients underwent treatment with etidronate, first with intravenous administration of 300 mg/day for 3 days followed by an oral administration of 20 mg/kg/day for 6 months. Eleven patients (27.5%) developed radiographic evidence of HO from 1.5 to 6 years after therapy. A low degree of HO was found in these patients; 8 had grade I and 3 had grade II ectopic ossification (Brooker's scale). The analysis of data showed that 2 different types of ectopic bone may form in the later stages after SCI. In 5% of patients, HO was found in the same anatomical site initially and finally, suggesting a "rebound" in mineralization of bone matrix not prevented by the administration of etidronate. The other type of HO was found in the majority of patients (95%) where the localization of HO showed different involvement of joints than initially, indicating de novo appearance of HO following SCI. The data suggest that etidronate given for a prolonged period in higher doses has, in addition to an inhibitory effect on crystal formation, a cellular effect on bone-forming cells.

Administration, Oral↗
PubMed2003

Genomewide linkage and linkage disequilibrium analyses identify COL6A1, on chromosome 21, as the locus for ossification of the posterior longitudinal ligament of the spine.

Ossification of the posterior longitudinal ligament (OPLL) of the spine is a subset of "bone-forming" diseases, characterized by ectopic ossification in the spinal ligaments. OPLL is a common disorder among elderly populations in eastern Asia and is the leading cause of spinal myelopathy in Japan. We performed a genomewide linkage study with 142 affected sib pairs, to identify genetic loci related to OPLL. In multipoint linkage analysis using GENEHUNTER-PLUS, evidence of linkage to OPLL was detected on chromosomes 1p, 6p, 11q, 14q, 16q, and 21q. The best evidence of linkage was detected near D21S1903 on chromosome 21q22.3 (maximum Zlr=3.97); therefore, the linkage region was extensively investigated for linkage disequilibrium with single-nucleotide polymorphisms (SNPs) covering 20 Mb. One hundred fifty positional candidate genes lie in the region, and 600 gene-based SNPs were genotyped. There were positive allelic associations with seven genes (P<.01) in 280 patients and 210 controls, and four of the seven genes were clustered within a region of 750 kb, approximately 1.2 Mb telomeric to D21S1903. Extensive linkage disequilibrium and association studies of the four genes indicated that SNPs in the collagen 6A1 gene (COL6A1) were strongly associated with OPLL (P=.000003 for the SNP in intron 32 [-29]). Haplotype analysis with three SNPs in COL6A1 gave a single-point P value of.0000007. Identification of the locus of susceptibility to OPLL by genomewide linkage and linkage disequilibrium studies permits us to investigate the pathogenesis of the disease, which may lead to the development of novel therapeutic tools.

Chromosome Mapping↗
PubMed1988

Ectopic ossification following total hip arthroplasty: is diffuse idiopathic skeletal hyperostosis a risk factor?

Total hip arthroplasty may be followed by ectopic bone formation. An increased frequency has been suspected in patients with diffuse idiopathic skeletal hyperostosis (DISH). In 204 patients we found that, of the 38 subjects with pre-existing DISH, 29% developed postoperative ossification compared with only 10% in those without DISH (p less than 0.01). DISH is therefore a risk factor for postoperative ectopic bone formation. In a separate study of 1325 patients (not analysed for spinal DISH), we looked for correlations between the severity of postoperative ectopic bone and clinical measurements. Even for the more severe ossification grades (n = 112), only 10% reported serious pain and only 26% had reduced hip flexion (less than 70 degrees). Thus, periprosthetic ectopic bone is not sufficiently important to justify the routine use of preventative drugs such as bisphosphonates in patients with DISH undergoing total hip replacement.

Adult↗