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[Research concerning the physiopathology of post-traumatic periarticular ossifications and anterior brachial muscle osteoma. Their prevention].

The author maintains that the osteoma of the brachial muscle as well as post-traumatic periarticular calcifications, occur in the muscle mass or in the tendon that prolongs it, or in the articular capsule, as a result of surgical treament and post-operative immobilization, and only exceptionally following orthopaedic treatment of traumatic lesions. Articular mobilization in the first week after osteosynthesis, or in the frame of conservative treatment, is not followed by osteoma of the brachial muscle or by calcifications surrounding the articulation, a fact that suggest that the presently applied therapeutic methods, which recommend strict and prolonged articular immobilization should be avoided. The development of ossification can be explained by post-traumatic changes in the muscular microcirculation, rendered more severe by surgical treatment and maintained by muscular inactivity. Early articular mobilization is the most efficient method of prophylaxis of these complications, which are determined not by the traumatic lesions themselves but by the present therapeutic methods applied.

Adult↗
PubMed2001

Surgery for ossification of the posterior longitudinal ligament of the cervical spine.

The authors present their surgical experience with fifty seven cases of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, operated between January 1992 and January 1999. Continuous OPLL was seen in the majority of patients (40/57). Posterior decompressive surgery was performed in 18 patients, a median corpectomy and excision of the OPLL in 28 and anterior segmental decompression in 11 patients. One patient had a transient weakness of muscles supplied by the C5 myotome following a C4-C5 corpectomy. 84.2% of the patients showed improvement by at least one grade at the time of discharge. 92.8% of patients who underwent a corpectomy improved in the immediate post-operative period as compared to 90.9% of those who underwent an anterior segmental decompression and 83.3% of those who underwent a posterior decompressive procedure. 97.7% of the 44 patients followed-up between one and five years showed neurological improvement. Thirty-two patients (72.7 %) had regained normal or near normal neurological function and returned to their jobs. Good results were obtained when the surgical approach and the procedure adopted were individualised.

Adult↗
PubMed2001

Focal nodular hyperplasia with calcification and ossification.

We describe a 33-year-old woman with Crohn's disease, who presented with recurrent episodes of small bowel obstruction. A solitary liver lesion was discovered incidentally by abdominal ultrasound. Pathological examination of the resected specimen revealed features typical of focal nodular hyperplasia together with uncommon findings including calcification, ossification and fibrous obliteration of blood-filled "cysts", changes more commonly associated with regression in hepatic haemangiomas. This report strengthens the favoured hypothesis that a vascular malformation underlies the pathogenesis of focal nodular hyperplasia.

Adult↗
PubMed2002

Heterotopic ossification.

Heterotopic ossification (HO) is the presence of bone in soft tissue where bone normally does not exist. The acquired form of HO most frequently is seen with either musculoskeletal trauma, spinal cord injury, or central nervous system injury. For example, patients who have recently undergone total hip arthroplasty or have paraplegia after spinal cord injury are at risk for HO. The fever, swelling, erythema, and occasional joint tenderness seen in early HO can be difficult to distinguish from cellulitis, osteomyelitis, or thrombophlebitis. Bone scanning and other imaging tests frequently are used to distinguish between these diagnostic possibilities. As treatment or prophylaxis for HO, either a nonsteroidal antiinflammatory drug (such as indomethacin), a diphosphonate (such as ethane-1-hydroxy-1,1-diphosphate), or local radiation therapy is recommended. Before therapy begins, bone scanning may be requested to confirm the diagnosis of HO. In addition, surgical resection of HO is used to preserve joint mobility; however, HO is likely to recur and possibly progress if resection is undertaken before the lesion has become mature. With a view toward avoiding recurrent HO and other operative complications, serial quantitative bone scans are used as an aid to time surgical intervention.

Bone and Bones↗
PubMed2002

Quadriplegia complicating ossification of the posterior longitudinal ligament.

We report a case of quadriplegia complicating ossification of posterior longitudinal ligament (OPLL) in a patient who was also found to have diffuse idiopathic skeletal hyperostosis (DISH). She also had osteomalacia (Vit. D deficiency) with secondary hyperparathyroidism. There could be a cause and effect relationship between the abnormal biochemistry and OPLL.

Adult↗
PubMed2002

[Left atrial myxoma with extramedullary hematopoiesis and ossification].

A 65-year-old female with palpitation was referred to our hospital for a further examination. Trans-esophageal and thoracic echocardiogram demonstrated a left atrial tumor with a patchy calcification, arising from the lower portion of the interatrial septum. It was completely extirpated together with its sessile pedicle and the related disc of interatrial septum. The tumor showed the extensive extramedullary hematopoiesis and ossification around scanty clusters of myxoma cells on light microscopy. These findings indicated further support to the belief that the primitive mesenchymal cell is the origin in cardiac myxoma.

Aged↗
PubMed2002

Early surgical management for heterotopic ossification about the elbow presenting as limited range of motion associated with ulnar neuropathy.

BACKGROUND: The formation of heterotopic ossification (HO) about the elbow after traumatic injury has been well documented in the literature. The optimal treatment, however, for ectopic bone associated with restricted range of motion and ulnar nerve entrapment syndrome has not been established. METHODS: Seven elbows with HO in 7 patients admitted to Chang Gung Memorial Hospital from April 1998 to January 1999 presented with limited range of motion and associated ulnar nerve neuropathy. All of these patients received early surgical excision of HO combined with release of the encased ulnar nerve and anterior transposition, followed by early gentle passive physical therapy and active exercise within the pain-free range of motion postoperatively. RESULTS: Almost full range of motion and complete functional ability following surgery were recovered in 6 of the 7 patients, while I patient who suffered from multiple traumatic injuries had limited improvement from 45 degrees ankylosis to 10 degrees approximately 90 degrees of a flexion-extension motion arc. CONCLUSION: Our results suggest that early surgical management combined with gentle physical therapy postoperatively is a feasible modality for treating patients with post-traumatic HO about the elbow presenting as limited range of motion and associated ulnar nerve compression syndrome.

Adolescent↗
PubMed2002

[A case of retroperitoneal serous cyst with ossification].

A 36-year-old woman came to our hospital complaining of right flank pain. Computed tomographic (CT) scanning showed a cystic mass, 6 x 9 cm in size, including homogeneous low-density fluid contents, in the right retroperitoneal space. The cyst wall showed partly high-density epithelium, but there was no contrast enhancement. A 7.5 x 12 cm retroperitoneal cyst was easily removed with yellow serous fluid in it. Cytological examination showed no malignant cells in this fluid. The origin of the cyst was unknown. The histopathological diagnosis was retroperitoneal serous cyst with focal ossification in the lining epithelium. Here we report this rare case of retroperitoneal serous cyst and briefly discuss 57 cases reported in Japan.

Adult↗
PubMed2001

Heterotopic ossification after lateral epicondylectomy.

Lateral epicondylitis is a common affliction that can be treated nonsurgically. However, surgical treatment is rarely indicated, and results are usually effective in more than 90% of patients. Although complications have been described, ours is the first report of heterotopic ossification after an uncomplicated lateral epicondylectomy.

Elbow Joint↗
PubMed1975

[Calcification and ossification of the posterior and longitudinal ligament of the cervical spine(author's transl)].

Three patients with calcification or ossification of the posterior longitudinal ligament of the cervical spine are described. This abnormality is very common in Japan. Descriptions from non-Japanese sources vary considerably. The practical significance of this abnormality consists of narrowing of the spinal canal, which may result in a myelopathy. Two of our patients are Chinese, the third was a white Dutchman.

Adult↗
PubMed2003

[Hypoglossal nerve palsy caused by hypoplasia of the atlas and ossification of the posterior longitudinal ligament].

A 50-year-old woman developed discomfort of oral cavity and dysarthria. Her tongue showed a slight left-deviation and atrophy in the left side in a month. Examination with X-p, CT, and MRI showed hypoplasia of the atlas and high cervical ossification of the posterior longitudinal ligament (OPLL) from C1 to C5. Thus, combination of congenital hypoplasia of the atlas and acquired high cervical OPLL reduced a function of hypoglossal nerve, which resulted in the palsy. In a case of unilateral hypoglossal palsy, a possible lesion of foramen magnum should be considered.

Cervical Atlas↗
PubMed1992

[Soft tissue ossification: mechanism].

Three experiments: cardiac ligature, subcutaneous implantation of glass diaphragm and regenerated calcaneus tendon transplantation, produce new bone with marrow. The mechanism proceeds in two steps: 1) after trauma or local irritation, mesenchymal fibroblasts enter in division; this young population remains fibrous indefinitely; 2) those young reactive cells, submitted to local oxygen deficiency, build new substances called "stress proteins". Under anoxia, a potent stressor, transplanted new calcaneus tendon ossifies and marrow develops in its core. No immigrant cells participate in this ossicle as it is rejected in a foreign host. Ectopic ossification is an active phenomenon, young fibroblast population building its own inductor, quite different from passive osteogenesis in which inductive message is produced outside the responsive cell. Fracture repair proceeds by an osteogenic reaction from both periosteum and marrow. A third factor is delivered by the cortex: osteogenin or BMP inductor. A fourth osteogenic factor is to be considered: "autoinduction by local stress anoxia".

Achilles Tendon↗
PubMed2003

Heterotopic ossification prophylaxis with indomethacin increases the risk of long-bone nonunion.

Indomethacin is commonly administered for the prophylaxis of heterotopic ossification (HO) after the surgical treatment of acetabular fractures. Non-steroidal anti-inflammatory drugs such as indomethacin, have been associated with delayed healing of fractures and mechanically weaker callus. Our aim was to determine if patients with an acetabular fracture, who received indomethacin for prophylaxis against HO, were at risk of delayed healing or nonunion of any associated fractures of long bones. We reviewed 282 patients who had had open reduction and internal fixation of an acetabular fracture. Patients at risk of HO were randomised to receive either radiation therapy (XRT) or indomethacin. Of these patients, 112 had sustained at least one concomitant fracture of a long bone; 36 needed no prophylaxis, 38 received focal radiation and 38 received indomethacin. Fifteen patients developed 16 nonunions. When comparing patients who received indomethacin with those who did not, a significant difference was noted in the rate of nonunion (26% v 7%; p = 0.004). Patients with concurrent fractures of the acetabulum and long bones who receive indomethacin have a significantly greater risk of nonunion of the fractures of the long bones when compared with those who receive XRT or no prophylaxis.

Acetabulum↗
PubMed1992

[A case of heterotopic ossification in the parapharyngeal region connected with the C2 vertebra in a 9-year-old girl].

A rare case of extraskeletal ossification in the parapharyngeal region related to C2 cervical vertebra was observed in a child, without any history of trauma, inflammation or endocrinological disease. One-step surgical intervention was carried out from the side of the neck and pharynx making possible complete removal of the lesion. The girl was admitted to the hospital with dysphagia and breathing difficulties increasing in the last 6 months. During that time the child was observed in laryngological hospital departments. After the operation Horner syndrome and hypoglossal paresis developed, but presently the child is without symptoms.

Axis, Cervical Vertebra↗
PubMed2003

Ectopic ossification in the parotid gland.

We present a unique report of ectopic ossification with dystrophic calcification within an otherwise histologically normal parotid gland. The histopathological features of the case are discussed and general pathogenetic explanations for the lesion are explored.

Female↗
PubMed2004

Lift-up laminoplasty for myelopathy caused by ossification of the posterior longitudinal ligament of the cervical spine.

BACKGROUND AND AIMS: We have utilized lift-up laminoplasty to treat patients with myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. The preliminary surgical outcome with computer-assisted morphological assessment is presented. MATERIAL AND METHODS: The surgical technique of lift-up laminoplasty includes standard posterior exposure of the cervical spine, en-bloc laminectomy, and expansion of the cervical canal by lift-up of the laminae with custom-designed hydroxyapatite laminar spacers and stabilization of the laminae using titanium miniplates. From 1998 to 2003, 10 consecutive patients with cervical myelopathy secondary to OPLL have been treated with this method and comprehensively evaluated. Care was taken to tailor the treatment to individual patients by using different sizes of spacers to adjust the degree of expansion depending on the amount of stenosis of the cervical spine. The degree of expansion of the cervical canal was altered by design, based on the preoperative imaging simulation. RESULTS: Preliminary surgical outcome, evaluated at 6 months after surgery, revealed a significant improvement of neurological function. Image analysis revealed that the cervical canals were significantly expanded, with a mean reduction of 13.1% in the stenosis ratio. Lift-up laminoplasty was effective in the treatment of patients with myelopathy secondary to cervical OPLL, and the amount of expansion could be individually adjusted at the discretion of the surgeon. CONCLUSION: Although analysis with a larger population and a longer follow-up period needs to be undertaken, our method of lift-up laminoplasty appears to be a viable choice among standard posterior cervical approaches for cervical OPLL.

Aged↗
PubMed2004

Thoracic myelopathy secondary to ligamentum flavum ossification.

INTRODUCTION: Focal ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy. The lower thoracic spine is most frequently affected and the patients present initially with posterior column disturbances followed by progressively increasing spastic paraparesis. The pathogenesis of OLF has not been conclusively established. MATERIALS AND METHODS: Five patients with thoracic myelopathy due to OLF underwent decompressive laminectomy and excision of the ligamentum flavum. Magnetic resonance (MR) images consistently revealed a linear or beak-like excrescence, uniformly hypodense on T1- and T2-weighted images, situated posterior to the thecal sac. A comparison of the preoperative neurological status and at followup was done using the Japanese Orthopaedic Association and Nurick scores modified for thoracic myelopathy. RESULTS: Decompressive laminectomy with excision of the OLF resulted in significant improvement in motor weakness and gait in 4 (1 excellent, 2 good, and 1 fair) patients who had slow-onset, but progressive compression, OLF. The patient who had acute traumatic spinal injury did not recover despite decompression and rehabilitation. All improved in their gait and spasticity, but 4 patients had persistent sensory deficit. CONCLUSION: OLF can significantly contribute to a spatial reduction of the thoracic spinal canal, resulting in slowly progressive paraparesis or acute paraplegia after trauma to the back. The T2-weighted sagittal image of MR imaging is the modality of choice for screening the longitudinal extent of OLF, with increased diagnostic accuracy when combined with computed tomographic myelogram. Neurological improvement usually occurs following decompression laminectomy with or without excision of the OLF. However, the persistence of residual numbness or weakness at follow-up may be due to irreversible changes within the cord as a result of severe thecal compression and the delay between the onset of initial symptoms/signs and surgical decompression. Prognosis remains poor for acute myelopathy with pre-existing OLF, despite surgery.

Aged↗
PubMed2004

L5 radiculopathy caused by ossification of the ligamentum flavum: a case report.

We describe a case of ossification of the ligamentum flavum in the thoracolumbar junction presenting as an L5 radiculopathy. Magnetic resonance imaging revealed a hypodense lesion on T2-weighted image at the T10-T12 level causing the right dural sac compression, and electrodiagnostic findings were compatible with the right L5 radiculopathy. The location and cause of the compression were confirmed by a surgery. The clinical findings and electrodiagnostic features of such lesions located at the thoracolumbar spinal junction are discussed.

Adult↗