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At least 1,261 records · Page 70Linked to original sources
PubMed2001

Anterior approaches to cervical spondylosis and ossification of the posterior longitudinal ligament: review of operative technique and assessment of 65 multilevel circumferential procedures.

BACKGROUND: Multilevel anterior cervical corpectomy with fusion (ACF) offers direct resection of spondylostenosis and ossification of the posterior longitudinal ligament (OPLL) with immediate stabilization. Ideal candidates for multilevel ACF include younger patients (<65 years of age), or older individuals (>65 years of age) with loss or reversal of the cervical lordosis (kyphosis). METHODS: Sixty-five patients, averaging 56 years of age and including 40 males and 25 females, with multilevel MR- and CT-documented spondylostenosis and OPLL were studied. Preoperatively, patients exhibited moderate to severe myelopathy (average Nurick grade 3.8), and were managed with 2- to 4-level ACF with posterior wiring and fusion (PWF) procedures with halo application. The first 22 patients had no plate instrumentation, the next 22 had constrained (Orion) plates applied followed sequentially by the application of 13 semi-constrained (Atlantis) plates, and finally, 8 dynamic (ABC Aesculap) plates. RESULTS: Patients improved an average of three postoperative Nurick grades. None exhibited new cord injuries, whereas three had transient C5 root paresis. Graft/plate or vertebral fracture with extrusion were observed in 3/22 nonplated patients, 2/22 constrained-plated patients, 3/13 semi-constrained-plated patients, and 0/8 dynamic-plated patients. Fusion was documented on dynamic radiographs and 2D-CT or 3D-CT studies obtained 3 and 6 months postoperatively, or later where indicated. CONCLUSIONS: Multilevel ACF/PWF offers direct resection of spondylostenosis and OPLL with immediate maximal stabilization. Thus far, no graft/plate or vertebral body fracture or extrusions have been seen with dynamic plates, whereas the absence of plating and constrained and semi-constrained plating systems have failed.

Adult↗
PubMed2002

Familial ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine: case report.

BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) of the spine is most common in the Japanese population and in the cervical spine. We present a case of OPLL of the lower thoracic spine in two Caucasian siblings. CASE DESCRIPTION: A 58-year-old female presented with lower extremity dysesthesia and urinary hesitancy. Family history was significant for a brother who had OPLL of the lower thoracic spine removed surgically. Magnetic resonance imaging and computed tomography scan of the thoracic spine demonstrated OPLL at T10-11 causing cord compression and abnormally high T2 signal in the cord. The patient underwent posterior decompression with improvement of her symptoms. CONCLUSION: A genetic predisposition to develop OPLL has been suggested by previous linkage and biochemical studies. While OPLL is an increasingly recognized diagnosis in North America, this is the first reported case of familial thoracic OPLL in Caucasian siblings.

Decompression, Surgical↗
PubMed1998

Evaluation and treatment of clinical instability associated with pseudoarthrosis after anterior cervical surgery for ossification of the posterior longitudinal ligament.

BACKGROUND: Between 1989 to 1993, clinical instability associated with pseudarthrosis was evaluated in 76 patients with cervical ossification of the posterior longitudinal ligament (OPLL). Average 2.5 level extended anterior diskectomy and fusion and average 3.0 level anterior corpectomy and fusion were performed without anterior plate instrumentation using iliac crest or fibular strut autografts. METHODS: Fusion versus pseudarthrosis resulting in clinical instability, as defined by White and Panjabi, was assessed using flexion and extension X-rays 3 and 6 months post-operatively. Radiographic instability was defined by > 3.5 mm. of sagittal plane translation (or 20%) and > 20 degrees of sagittal plane rotation on dynamic X-rays. Two and 3 dimensional (D) computed tomography (CT) scans, also obtained 3 months postoperatively, either confirmed fusion or indicated failed bony union. The average clinical follow up period was 3 years (range, 25-52 months). RESULTS: Three months postoperatively, dynamic X-rays in 20 patients demonstrated radiographic instability consistent with pseudarthrosis, whereas 2 and 3D CT studies indicated a lack of fusion. At 6 months, flexion and extension X-rays revealed that 10 patients were fused and that another 7 were clinically stable despite persistent, irregular, linear lucencies at graft/body interfaces. Three (4%) patients with clinical instability associated with pseudarthrosis required secondary posterior wiring and fusion. CONCLUSION: Only 4% of patients undergoing average 2.75 level anterior OPLL surgery without anterior plate instrumentation required secondary posterior wiring and fusion for clinical instability associated with pseudarthrosis.

Aged↗
PubMed1999

Surgical approach to ossification of the thoracic yellow ligament.

BACKGROUND: Symptomatic ossification of the yellow ligament (OYL) at the lower thoracic level is uncommon. Although wide laminectomy has, until now, been the primary treatment for this disease, we propose a less invasive technique based on a new method of three-dimensional computed tomography (CT). METHODS: The clinical features and radiologic imaging findings of 37 patients with OYL (mean age, 54 years) were analyzed. The surgical approach was selected based on the position of the depicted OYL on 3D CT scan in each patient. RESULTS: The male-to-female ratio was 3:1. Involvement of the upper thoracic region was seen 11 times; of the middle region 8 times, and of the lower region 40 times (several patients had involvement in more than one region). About half of the patients complained of gait disturbance on admission caused by the markedly enlarged OYL. No postoperative complications were found. Neurologic deterioration was observed in only one patient. CONCLUSIONS: OYL should be treated as early as possible, using the least invasive technique available. By using 3D CT, we were able to perform limited surgery consisting of foraminotomy or extended partial laminectomy at the affected level after confirming the anatomic location of the OYL. In laterally extended OYL, it is necessary to decompress the radicular artery in order to prevent ischemic damage to the spinal cord.

Aged↗
PubMed1999

Anterior cervical micro-dural repair of cerebrospinal fluid fistula after surgery for ossification of the posterior longitudinal ligament. Technical note.

BACKGROUND: Cerebrospinal fluid (CSF) fistulas may occur during anterior cervical surgery performed for the resection of ossification of the posterior longitudinal ligament (OPLL), as OPLL occasionally erodes to and through the dura. These fistulas have been variously managed with gelfoam, dural substitutes sutured in place, fibrin glue, lumbar drains, and lumboperitoneal shunts. However, more adequate dural repair is now feasible with the 1.4-mm microdural titanium stapler. METHODS: A 59-year-old female with OPLL and moderate to severe myelopathy (Nurick Grade IV) had a C3-C7 anterior corpectomy with fusion using Orion plates followed by a C3-T1 posterior wiring and fusion with halo application. During the anterior approach, a 5-mm CSF fistula at C4-C5 was directly repaired under the operating microscope using a 1.4-mm microdural stapler, bovine pericardial graft, and fibrin glue. Immediately postoperatively, a lumboperitoneal shunt was also placed. RESULTS: Postoperatively, her myelopathy improved to a mild to moderate level (Nurick Grade II). Her acute left deltoid plegia resolved within 3 months. CONCLUSIONS: The 1.4-mm microdural stapler makes "watertight" closure of anterior cervical CSF fistulas more feasible.

Animals↗
PubMed2002

[Treatment of neurogenic heterotopic ossifications (NHO) in brain injured patients: review of literature].

This article is a review of the literature about treatment of neurogenic heterotopic ossifications (NHO) in brain injured patients, from analysis of the main data bases (Medline, Embase, Reedoc). In spite of the hope they arouse in the seventies, biphosphonates, including etidronate, have not demonstrated their efficiency to inhibit NHO in clinical practice. In fact a very early diagnosis, with the scintigraphic overactivity of the joint area and the increase of serum alkaline phosphatases, must lead to begin passive motion and postures, and may contribute to save functional range of motion. Yet, when joint stiffness or even ankylosis have led to severe functional disorders, surgery with NHO resection is the only way; it looks more reliable to manage it when NHO is mature, after a delay of more than 12 months after the first signs, but earlier operations have been reported without an enhanced risk of recurrence; this surgery must be associated with continuous passive motion for several weeks; radiation therapy and/or non-steroid anti-inflammatory drugs have been proposed in the immediate after-surgery period, but their role is still discussed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2002

[Neurogenic ectopic ossification: a physiatry update].

The first aim of this paper is to present a critical review of the existing literature on neurogenic ectopic ossification. The second aim is to introduce the two papers published in this issue of the journal. In addition, etiopathogenic aspects are described as well as some insights in classical therapies and new therapeutic options which could prove to be useful in the near future.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

A prospective evaluation of the timing of postoperative radiotherapy for preventing heterotopic ossification following traumatic acetabular fractures.

PURPOSE: Preoperative and immediate postoperative irradiation of traumatic acetabular fractures (TAF), although known to reduce heterotopic ossification (HO), can cause significant organizational and logistic difficulties. We sought to determine an acceptable time interval between surgery and radiation without compromising control, as well as to update our large experience and to further validate our treatment philosophy. METHODS AND MATERIALS: Beginning in June 1995, we began a prospective study, irradiating 152 patients on postoperative days 1, 2, or 3. There were also 17 patients delayed further secondary to medical difficulties. RESULTS: All patients treated since June 1995 received 700 cGy/1 fx. Fifty-eight patients received radiation within 24 hours of surgery, 41 within 2 days, 53 within 3 days, 13 within 4 days, and 4 were delayed further. Delaying irradiation for up to 4 days postoperatively caused no statistical increase in HO (p = 0.625). Of 263 patients in our retrospective cohort, HO occurred in 5.3% of patients who received irradiation versus 60% of patients who did not. CONCLUSION: In our prospective study, we noted no perceptible increase in HO with up to a 3-day interval between surgery and radiotherapy. This allows a more structured treatment schedule and allows the patient more time to heal and recover. Updated results from our overall series continue to demonstrate that adjuvant radiation decreases the incidence and severity of HO after TAF.

Acetabulum↗
PubMed1998

Preoperative vs. postoperative radiation prophylaxis of heterotopic ossification: a rural community hospital's experience.

PURPOSE: In vivo data employing a rat model, suggest equivalent suppression of ectopic bone formation by single-fraction irradiation given either pre (< or = 4 h)- or post (< or = 24 h)-surgery. Two subsequent randomized clinical trials, from tertiary academic centers with robust experience in heterotopic bone prophylaxis, have reached similar conclusions. To assess the transferability of the above data to the community setting we reviewed our rural community hospital experience with pre- and postoperative radiation prophylaxis. METHODS AND MATERIALS: Between 11/90 and 6/96, 16 surgerized hips with high risk of heterotopic bone formation received 7.00-8.00 Gy in one fraction either preoperatively (< or = 4 h) (n = 9) or postoperatively (< or = 3 days for six hips; day 7 for one hip) (n = 7). Initial patients were routinely treated postoperatively. In late 1992, treatment preference was switched to preoperative irradiation in response to evolving data. The two groups were similar with respect to age, sex, nature of surgery, presurgical Brooker and Harris scores, and in U. of Rochester risk classification distribution. Irradiation was given via 4-20 MV photons through equally weighted AP:PA portals to the periacetabular tissues and proximal one third to one-half of the femoral component. Radiation dose, energy, portal, and blocking design were all similar for the two groups. Hip radiographs were obtained immediately postsurgery and at last follow-up: Delta grades (Brooker grade at follow-up--Brooker grade immediately postsurgery) were computed. Harris scale scores of hip function and movement were assigned via personal interviews and examinations performed prior to irradiation and at last follow-up. RESULTS: All 16 hips are evaluable. Follow-up interval among the post-operative group (mean = 39.8 months; range 18.6-65.8) was significantly longer than among the preoperative group (mean = 20.4 months; range 8.6-41.3) (p < 0.02). The mean Delta grade among the postoperative and preoperative groups was identical (-0.02). Similarly, improvement in Harris scale scores, from preirradiation to last follow-up, were nonsignificantly different among postoperative (+43.3) and preoperative (+44.8) groups. There was one postoperative infection in either group; there was no acute or late toxicity attributable to irradiation. CONCLUSION: As heterotopic bone formation is complete within 6 months, the data for both treatment groups may be considered mature. Our community generated results parallel those derived from tertiary care centers. Single-fraction radiation prophylaxis of heterotopic ossification may be given with similar efficacy either < or = 4 h pre- or < or = 24 h postsurgery. For reasons of minimizing patient discomfort, postsurgical movement and radiation staff resource utilization, we prefer and recommend preoperative radiation prophylaxis.

Aged↗
PubMed1999

Utility of radiation in the prevention of heterotopic ossification following repair of traumatic acetabular fracture.

PURPOSE: Heterotopic ossification (HO) is a common problem following surgical repair of traumatic acetabular fracture (TAF), potentially causing severe pain and decreased range of motion. This report analyzes the role of radiation therapy for prevention of HO in TAF. METHODS AND MATERIALS: The charts of all patients who received RT to the hip following TAF repair between July 1988 and January 1998 were reviewed. Sixty-six patients were identified. RT was given in 5 fractions of 2 Gy in 45 patients, 1 fraction of 8 Gy in 17 patients, and other doses in 4 patients. Treatment fields encompassed periacetabular tissues at highest risk for HO. Time to RT was < or = 24 hours for 46 patients. RESULTS: Radiographic follow-up at least 6 months following RT was available in 47/66 (71%) patients to permit Brooker classification, revealing 6 cases (13%) of Grade III HO, compared to historical incidence in this population of 50%. No Grade IV HO was found. Mean follow-up was 18 months. Four of the Grade III patients had received 10 Gy/5 fractions, and 2 received 8 Gy/1 fraction. Postoperative wound infection occurred in 6 patients, and osteonecrosis of the femoral head was found in 13. CONCLUSIONS: RT following surgical repair of TAF provides effective prophylaxis against formation of clinically significant HO. We recommend a single fraction of 7-8 Gy within 24 hours of surgery to prevent HO formation and minimize patient discomfort.

Acetabulum↗
PubMed1998

Ossification of the ligament flavum.

A total of 82 patients who underwent spinal computed tomographic scan, in an 8-month period at the King Khalid University Hospital, Riyadh, Saudi Arabia, were analyzed for age, sex, the presence/absence, site, and type of ossification of the ligamentum flavum (OLF) as well as associated diseases. The OLF was radiographically present (bilaterally or unilaterally) as linear (74.5%) or nodular types (25.5%). The linear type was especially seen at the inner aspects of the ligamentum flavum. OLF was present in 35.4% of patients, and was seen at single and multiple levels in 51% and 41% of them, respectively. OLF was identified in a total of 47 levels in the study group and was associated with other disease in the spine in 38 (81%) of these levels. In none of the patients was OLF the cause of myelopathy. The incidence of OLF and its pathogenesis and significance are discussed. This paper is the first report of OLF from the Middle East. OLF in this part of the world is usually asymptomatic.

Adolescent↗
PubMed2003

Biochemical markers of bone turnover and development of heterotopic ossification after total hip arthroplasty.

We studied biochemical markers of bone turnover markers in 20 men and women over 26 weeks after total hip arthroplasty (THA) in order to characterize the changes in bone metabolism associated with developing heterotopic ossification (HO). Transient increases in biochemical markers of both osteoclast and osteoblast activity occurred after surgery. Subjects developing HO (n=9) had greater rises in the osteoclast marker C-telopeptide of type-I collagen (CTX-I; ANOVA P=0.004), and the osteoblast markers N-terminal propeptide of type-I procollagen (PINP; ANOVA P=0.01) and osteocalcin (OC; ANOVA P=0.02) than those who did not develop HO. A rise of >42% in CTX-I at one week after surgery had a sensitivity of 89% and a specificity of 82% for predicting HO development at week 26 (P<0.05). Rises of >57% in PINP and >13% in OC at week 6 had sensitivities of 89% and 56%, and specificities of 82% and 91%, respectively for development of HO. Transient increases in osteoblast and osteoclast activity occur after THA. These changes are greater in patients developing HO than in those who do not develop HO. The potential applications of these markers are as a non-invasive, radiation-free tool for investigating the pathogenesis of HO, and as an early surrogate outcome marker for HO development in clinical trials of novel prophylaxis regimes for its prevention.

Adult↗
PubMed1992

[A case of primary intraneural ossification of the ulnar nerve].

The authors report a case of ossification of the ulnar nerve at the elbow. The dense bone tissue spread into the interfascicular space while the epineurium and the fasciculi were undamaged. The pathological tissue was removed and the patient recovered. No similar report has been found in the literature.

Female↗
PubMed2003

Heterotopic ossification after total knee arthroplasty.

The incidence of heterotopic ossification (HO) after total knee arthroplasty (TKA) and its effect on the postoperative range of motion (ROM) were assessed in 63 primary TKAs. Twenty-five of 63 knees (39%) showed postoperative HO, most of which were found in the region anterior to the distal femur. The incidence of HO was significantly higher (P <.05) in the osteoarthritic knees than in the rheumatoid knees. Significant positive correlation was seen between the preoperative grade of osteophyte formation and the incidence of postoperative HO. The ROM in the knees with HO was not significantly different than that in the knees without HO at 1 year after surgery. Thus, we concluded that HO after TKA is a self-limiting condition and its pathogenesis is completely different from that of myositis ossificance.

Aged↗
PubMed2003

The efficacy of 500 CentiGray radiation in the prevention of heterotopic ossification after total hip arthroplasty: a prospective, randomized, pilot study.

A prospective, randomized, pilot study comparing 500 cGy (group A) versus 1,000 cGy (group B) radiation treatment for the prevention of heterotopic bone in a consecutive group of high-risk patients undergoing total hip arthroplasty was performed. Treatment was initiated within ninety-six hours and given in equal, divided doses: 2 doses for group A and 5 doses for group B. No statistically significant difference was found in the demographics between the 2 groups. At follow-up evaluation, the distribution of heterotopic bone according to the Brooker classification was: group A, 9 class 0, 17 class 1, one class 2, and 2 class 3. Group B: 17 class 0, 10 class 1, 2 class 2, and one class 3. This difference was not statistically significant (P=.086). Only 3 cases were considered treatment failures, for a success rate of 93% in group A and 97% in group B. As a result of this pilot study, 500 cGy radiation treatment appears to be effective in the prevention of clinically significant heterotopic ossification after total hip arthroplasty.

Adult↗
PubMed1996

Heterotopic ossification. Incidence in cemented versus cementless total hip arthroplasty.

To resolve the debate whether cementless total hip arthroplasty (THA) carries an increased risk of heterotopic ossification (HO) as compared with cemented THA, 100 patients undergoing primary cemented THA (both acetabulum and femur) were individually matched to 100 patients undergoing primary cementless THA. Preoperative, 6-week postoperative, and 2-year postoperative radiographs were reviewed for the presence of HO using the Brooker classification. No subject in either group received any postoperative prophylaxis for HO. The matching parameters were age ( +/- 10 years), sex, weight ( +/- 10 lb.), diagnosis (all were osteoarthritis), Charnley class (A/B), and surgical approach (trochanteric osteotomy or modified Hardinge). The overall incidence of HO was 68% in the cemented group and 65% in the cementless group. The extent of HO (grade III) was significant in 9% of the cemented group and 5% of the cementless group. There was no grade IV HO (bone ankylosis) in either group. Neither the overall incidence nor the incidence of grade III HO was statistically different between the two groups. Patient sex and surgical approach had no interactive effect with type of component fixation on the incidence of HO. Fear of HO should not be a factor in the choice of fixation for THA.

Aged↗
PubMedDate not supplied

Reactive heterotopic ossification. Its patterns on MRI.

The purpose of this report is to analyze common features of reactive heterotopic ossification, zone phenomenon and involution. Eleven cases evaluated with plain radiography and MRI were classified based on the location: intramuscular, periosteal, and intermediate (mainly the insertion site of muscles). Zone phenomenon tends to be complete in the intramuscular type and incomplete in the periosteal type. Involution is also more evident in the intramuscular type.

Adolescent↗