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[Rare causes of ossification of the posterior common vertebral ligament causing cervical compression. Apropos of 2 cases].

The ossification of the posterior longitudinal is always responsible of cervical myelopathy. Radiological study and the CT scan, are able to precise the level, the morphologic and associated abnormalities of this lesion. Two cases of ossification of the posterior longitudinal ligamentum with cervical myelopathy are reported. The radiologic studies determined the etiology, in the first case, it was fluorosis and the second DISH disease.

Aged↗

[Surgical treatment for ossification of the posterior longitudinal ligament of the cervical spine].

The surgical results in 37 patients with cervical myelopathy due to ossification of the posterior longitudinal ligament of the cervical spine were described. This series consisted of 32 patients who underwent anterior decompression with anterior cervical fusion using bone grafts obtained from cervical vertebral bodies, and 5 patients who underwent expansive laminoplasty or laminectomy as a method of posterior decompression. 6 out of 32 patients with anterior cervical fusion were operated on at one level, 18 at two levels and 8 at three levels. The patients were out of bed within two days and treated using a soft collar for 3 months. In all patients, the symptoms improved postoperatively. Postoperative X-ray films showed solid bone fusion in all patients with anterior cervical fusion at a mean follow up time of one year and nine months (range 6 months to 3 years 6 months). Anterior angulation was found in one (3%) out of 32 patients who underwent anterior cervical fusion. Concerning the method of operation, the authors think that anterior decompression is to be recommended for cases with ossification within three consecutive vertebrae and posterior decompression should be applied to cases in which anterior decompression is very difficult. If necessary, a two-stage combined decompression is recommended.

Adult↗

Heterotopic ossification around the hip joint in spinal cord injured patients.

Thirty patients with heterotopic ossification following spinal injuries were divided into acutely-injured and post-surgical groups. Patients in the acutely injured group had symptoms of heterotopic ossification within 6 months of injury. The formation and maturation of the heterotopic bone around the affected hip(s) were studied by serial alkaline phosphatase determinations and radiographic examinations. Radionuclide bone scans using 99m Technetium diphosphonate were made in all patients. Treatment consisted of maintaining range of motion. This appears to be a self-limiting process as maturation occurs. Surgery was not necessary in this group. In patients with mature deposits, wedge and segmental resection of the extraosseous bone was necessary to regain enough hip flexion for the patinets to sit. This was followed by vigorous joint ranging. After one year, average range of recovered flexion was 60 degrees.

Adult↗

[Atypical ossification of anomalous ribs].

Atypical ossifications of anomalous ribs were found in 22 cases of 400.000 fluorograms with rentgenological control (0,005% or 1:18.000). Among them there were 15 cases on the right side, 6--on the left and one bilateral case in the third ribs. The fourth ribs were altered more frequently (12) and the fifth one--less frequently (9). Atypical ossifications were observed only in forked bifurcations of anterior ends which may serve as one of differential diagnostical signs for distinguishing them from other pathological changes.

Humans↗

Age- and joint-specific risk of initial heterotopic ossification in patients who have fibrodysplasia ossificans progressiva.

Using data from a survey of 44 patients who have fibrodysplasia ossificans progressiva, age- and joint-specific risks of new joint involvement were estimated using parametric and nonparametric statistical methods. Regions in which the risk of heterotopic ossification appears to remain constant with age include the neck, spine, shoulders, elbows, and ankles. Regions with apparently increasing risk include the jaw, wrists, hips, and knees. This analysis allows clinicians to estimate the risk of new involvement for any joint at any patient age, as well as the fraction of patients with uninvolved joints at any age. The variation of ossification risk by joint provides a clinically useful guide to the patterns of progression of the disease. Such a guide will help in planning for individual patient needs, as well as anticipating auxiliary social services and rehabilitation programs.

Adolescent↗

[Clinicopathologic analysis of ossification in spinal meningioma].

Calcification such as psammoma body is sometimes found especially in spinal cord meningioma but ossification of the meningeal tumor was rarely observed. Two cases of ossificated spinal cord meningiomas, located extramedullary intradurally apart from spinal bone, were clinicopathologically analyzed. The patients were 75-year-old female with meningioma at T9-10 level and 60-year-old female with one at T6-8 level. With pathological examination, concentration of psammoma bodies is not related to the formation of bone tissue. Metaplasia of arachnoid cell is seemed to be the origin of the bone structure.

Aged↗

Stylohyoid chain ossification: choice of the surgical approach.

The embryological, clinical and radiological features of an abnormal stylohyoid chain ossification is reviewed. The common embryological origin of the styloid apophysis, the styloid ligament and the lesser cornu of the hyoid bone allows the concept of a stylohyoid entity. The pathogenesis of the ossification of the stylohyoid chain enables us to distinguish Eagle's syndrome, the stylohyoid syndrome and the pseudo-stylohyoid syndrome. The choice between medical and surgical treatment particularly surgery by external approach, is discussed.

Female↗

[Renal cell carcinoma accompanied with ossification: a case report].

Renal cell carcinoma accompanied with ossification reported in Japan is very rare. We report a case of renal cell carcinoma with ossification pathologically in a 61-year-old woman. She suddenly presented with hypercalcemia that caused acute renal failure, 6 months after the operation and died shortly thereafter. We discuss the relationship between the tumor and the hypercalcemia.

Acute Kidney Injury↗

Effect of transforming growth factor-beta on fibroblasts in ossification of the posterior longitudinal ligament.

We studied the immunohistochemical localization of TGF-beta in the ligament tissue of patients with ossification of the posterior longitudinal ligament (OPLL), and the effects of TGF-beta on cultured cells derived from the spinal ligament of patients with OPLL. ALP activity in the cultured cells was also examined. TGF-beta was present in the ossified matrix and in the chondrocytes in cartilaginous areas adjacent to OPLL. ALP activity was high in the cultured cells of OPLL patients. Exogenous TGF-beta inhibited proliferation in the OPLL cells but promoted proliferation in control cells. These results suggest that the spinal ligaments of OPLL patients have an osteogenetic predisposition and that TFG-beta may play a role in the ossification.

Animals↗

Heterotopic ossification after total knee arthroplasty.

Heterotopic ossification (HO) is a rare complication following total knee arthroplasty (TKA). In the case report presented, a 52-year-old man who had previously undergone TKA for osteoarthritis noticed painful limitation of range of motion (ROM) in spite of active participation in physical therapy and the use of a continuous passive motion machine. A plain radiograph 1 month after surgery revealed HO anterior to the distal femoral shaft in the quadriceps expansion. Ambulation for this patient was limited to short distances because of severe pain and limitation in ROM. The patient underwent manipulation under general anesthesia 2 months after the TKA. Range of motion in flexion improved from 50 degrees to 110 degrees, and the patient became ambulatory without assistive devices. However, the flexion range deteriorated to 50 degrees over a period of 4 months, and ambulation again became significantly limited. The patient underwent resection of HO 6 months after manipulation and regained his ROM to 110 degrees in flexion. He was prescribed indomethacin after surgery for 2 months to prevent recurrence of HO. Follow-up radiographs 3 months after surgery revealed minimal recurrence of HO. The patient's ROM did not deteriorate, and he remained ambulatory. Heterotopic ossification should be suspected in post-TKA patients if ROM does not improve. Physical therapy including ROM exercises remains an essential component in the treatment of HO. Manipulation under general anesthesia or surgical resection of HO may be inevitable in certain patients whose ambulation is significantly limited.

Humans↗

[The use of radiotherapy in the prevention of heterotopic ossification in patients with total hip replacement].

In order to prevent heterotopic ossification (HO) after total hip replacement, 21 high risk hips were irradiated pre- and postoperatively to prevent heterotopic bone formation in the St. Paul Department of Radiation Oncology from 1993 to September, 1995. Eighteen hips in 15 patients were eligible for analysis with a minimum follow-up of 3 months. All the hips in our series were at high risk of heterotopic bone formation. All assessable patients had radiographic findings of ipsilateral or contralateral previous ectopic bone formation, 8 following total hip arthroplasty, 4 following trauma and 3 had heterotopic osteoarthritis. Four hips were treated 46 hours preoperatively, while all the others were treated on the first postoperative day. The irradiation field was limited to the hip region and radiation exposure to a rectangular field, ranging in size from 8 x 12 to 10 x 15 cm, to include the lateral aspect of the greater trochanter. We used a cobalt-60 unit. Opposed anterior-posterior fields were irradiated at midplan, with a source-to-axis distance of 80 cm; the dose was 6-8 Gy in one fraction. Preoperative irradiation appeared as effective as postoperative treatment, and more comfortable for the patients. There were neither side-effects nor failure of ossification. The treatment appeared effective in the prophylaxis of HO in 88% of patients, with clinical advantages in 67% of them.

Follow-Up Studies↗

Potential role of streptozotocin in enhancing ossification of the posterior longitudinal ligament of the cervical spine in the hereditary spinal hyperostotic mouse (twy/twy).

We investigated the effects of streptozotocin-induced diabetes mellitus on ossification of the posterior longitudinal ligament (OPLL) in the murine cervical spine. A genetically-bound spinal hyperostotic mouse, the tip-toe walking Yoshimura (twy) mouse, was used in these experiments. Histological examination showed that streptozotocin enhanced membranous and enchondral ossification of the posterior longitudinal ligament of the cervical spine, particularly in the area of the ligamentous enthesis. It also increased the number of alkaline phosphatase-positive osteoblast-like mesenchymal cells particularly around the enthesis, while the number of such cells was less in control twy mice and ICR mice treated with streptozotocin. The area of OPLL subsequently increased in size in streptozotocin-treated twy mice. We suggest that streptozotocin-induced diabetes enhances OPLL in the genetically-bound spinal hyperostotic mouse (twy/twy).

Age Factors↗

[The differential diagnosis of posttraumatic ossifications in the area of the elbow joint in children].

Clinico-roentgenological observations of 64 patients aged from 4 to 14 years with posttraumatic ossifications in the elbow joint area, of whom 25 were operated upon, enabled the authors to compare the data obtained with the well-known signs of osteogenesis of another etiology. The case history and x-ray examinations are thought by the authors to be the most important methods allowing the nature of this osteogenesis to be differentiated. The main distinctive signs of the posttraumatic ossifications are the development of their roentgenological stages in the special chronological succession.

Adolescent↗

A case of bilateral ulnar nerve palsy in a patient with traumatic brain injury and heterotopic ossification.

Heterotopic ossification after head injury may occur in the elbow joint. Rarely does this lead to entrapment of the ulnar nerve. We describe the case of a 20-year-old patient who developed heterotopic ossification 6 weeks after a traumatic brain injury. She subsequently developed bilateral ulnar nerve palsy which was confirmed by electrodiagnostic studies and treated by transposition of the ulnar nerve.

Adult↗

A case report of idiopathic pulmonary ossification.

Idiopathic pulmonary ossification is a rare disease. Most commonly, it affects middle-aged men. Its etiology is unknown. We present a case of nodular type idiopathic pulmonary ossification in a 42-year-old, white male who had one episode of hemoptysis.

Adult↗

[Disseminated pulmonary ossification. Case report].

Metaplastic pulmonary ossification is usually described as dendriform or nodular in patients with chronic inflammatory lung disease or long-standing pulmonary edema. We present a case of dendriform pulmonary ossification found accidentally at autopsy in a 66-year old man. In addition, some of the theories relating to the development of this rare phenomenon are discussed.

Aged↗