摘要:

To evaluate the genetic background of ossification of the posterior longitudinal ligament, the relationship between the presence or absence of ossification and human leukocyte antigen haplotypes was studied in 33 families of patients with ossification of the posterior longitudinal ligament. The study revealed that human leukocyte antigen haplotypes formed certain types of clusters, and that some human leukocyte antigen haplotypes were very rare in the Japanese population, suggesting the involvement of human leukocyte antigen-linked factors in the pathogenesis of ossification of the posterior longitudinal ligament of the cervical spine. In the families of these patients, ossification of the posterior longitudinal ligament was demonstrated by radiography in 56% (10/18) of the siblings. Each of these siblings shared both human leukocyte antigen haplotypes with the patient. None of those who shared only one human leukocyte antigen haplotype with the patient had developed ossification of the posterior longitudinal ligament. From these findings, the presence of both pathogenic human leukocyte antigen haplotypes is considered to be necessary for the development of ossification of the posterior longitudinal ligament, and this genetic predisposition may be activated by multiple factors, including regressive degeneration due to aging and the environment.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Magnetic resonance imaging findings were compared with histopathologic specimens of ossified or calcified ligaments, including the surrounding tissue, to evaluate the usefulness of magnetic resonance imaging as a means to predict the progression of ossification. In addition, factors influencing signal intensity were evaluated by histochemical and immunohistochemical analyses. The area of low signal intensity corresponded to the hyperplastic ligament around the ossification, and to the transitional area between the ligament and the ossification. A mineralization front and chondrocyte proliferation with strong metachromasia were recognized in these areas. The presence of a low-intensity signal area suggested the progression of ossification. The isointensity signal corresponded to proliferation of small vessels in the hyperplastic ligament, presumably representing the initiation of ossification. Histochemically, the metachromasia was intense at the transitional area between the ligament and the ossification, and the main constituent in these areas was chondroitin sulfate. Immunohistochemically, S-100 protein, transforming growth factor-β1, and Type II collagen showed an intense immunoreactivity in the chondrocytes, indicating increased production of the extracellular matrix. We postulate that the activation of chondrocytes and the alteration of the extracellular matrix may have affected the signal intensity.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Magnetic resonance imaging and histologic features of hypertrophic cervical posterior longitudinal ligament were determined in a cervical myelopathy patient. On T1-weighted images, the thickened ligament and the prolapsed nucleus pulposus showed isointensity shadows, making it impossible to differentiate these tissues. On T2-weighted images, the thickened ligament and prolapsed nucleus pulposus were visualized at high and low intensity, respectively. Sagittal T1-weighted images after gadolinium-diethylene triamine pentaacetic acid injection showed obvious enhancement of the thickened ligament.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A new method has been devised for obtaining high-quality cervical myelograms safely and easily through lumbar injection. This method uses simple radiographic equipment, and does not require a tiltable table or fluo-roscopy. Fifty-seven patients with cervical disorders were examined by this method using 9.5 ml of iohexol (300 mg μl/ml), and successful myelograms were obtained in all patients. No serious complications were encountered.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Evaluation was done of 65 patients with cervical myelopathy treated by bilateral open laminoplasty using artificial laminas, between 1984 and 1988, who had been followed for more than 2 years. The mean recovery rate on the Japanese Orthopaedic Association scoring system was 65% in all cases, and 72% in the cases with no other complications. The artificial laminas appeared well adapted to the laminas in computed tomography and dynamic radiographic examinations, and there were no cases of reduction of the enlarged canal. Postoperative restriction of the range of motion of the cervical spine was lessened by the positioning of lateral grooves, more appropriate external fixation, and posterior flexion exercise after operation. This procedure is not technically complicated, it does not involve appreciable blood loss during operation, it prevents grafted free fat from migrating into the spinal canal, and is advantageous for poster-olateral bone chip grafting.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Neurologic complications resulting from surgery for 384 cases of cervical myelopathy (cervical soft disc herniation, spondylosis, ossification of the posterior longitudinal ligament) were reviewed. Surgical procedures performed included 134 anterior interbody fusions (Cloward or Robinson-Smith technique), 70 subtotal corpectomies with strut bone graft, 85 laminectomies, and 95 lamino-plasties. Twenty-one patients (5.5%) sustained neurologic deterioration related to surgery. The deterioration was classified into two types on the basis of the neurologic signs observed: deterioration of spinal cord function or of nerve root function. Manifestations of the former varied from weakness of the hand to tetraparesis. Paralysis of the deltoid and biceps brachii muscles was an exclusive feature of deterioration in the nerve root group. Causes of this paralysis included malalignment of the spine related to graft complications, and a tethering effect on the nerve root following major shifting of the spinal cord after decompression. The causes of deterioration of the cord function included spinal cord injury during surgery, malalignment of the spine associated with graft complication, and epidural hematoma.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To determine the functional changes occurring in the early period after the development of chronic cord compression, an ossification of the ligamentum flavum model, which is a model of chronic cord compression, was created in domestic rabbits using bone morphogenetic protein, and monitored evoked spinal cord potentials. Sixty-seven rabbits were used for these experiments. Myelography, evoked spinal cord potential measurements, and histologic examinations were performed in 16 of the ossification of the ligamentum flavum rabbits and six of the healthy control rabbits. Our results show that 1) mild degrees of cord compression produce greater evoked spinal cord potential alterations in chronic than in acute compression, as reported in the literature; 2) chronic compression from the dorsal side produces injury in the superficial layer of the dorsal column and dorsolateral column; and 3) changes in evoked spinal cord potentials precede the development of paralysis and histologic changes.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Functions of the lower extremities and bowel and bladder must be monitored during releasing surgery for tethered spinal cord syndrome, because neural elements are embedded in lipoma or anomalous tissues. Evoked muscle action potentials of the external anal sphincter muscle, external urethral sphincter muscle, and lower extremity muscles can indicate promptly whether or not neural elements are involved before the surgeon releases or cuts the tissue for cord release. It is also important to monitor vesical pressure because of different types of innervation from the external urethral and anal sphincters, in spite of slow reaction times of vesical pressure elevation. Evoked muscle action potentials indicate only motor function; therefore, it is more appropriate to record evoked spinal cord potentials from the spinal cord above a lumbosacral operative field, because sensory function can also be monitored. Evoked muscle action potentials are an easy and extremely sensitive monitoring system; nevertheless, monitoring of vesical pressure and evoked spinal cord potentials should also be done to achieve optimum monitoring. For the past 5 years, 10 patients have undergone cord-release surgery with such a monitoring system, and the results indicate no exacerbating case.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Thirty patients over the age of 10 years, exhibiting cutaneous manifestations on the back suspected to be due to spinal dysraphism, and neurologic deficits, were studied to analyze neurologic appearance. Neurologic deficits appeared by age 5 in 26 patients. No patient complained of low-back pain or sciatica. Paralytic deformities of the lower extremities were divided into four grades for evaluation: A = no deformity, with only urinary disturbance (four cases); B = toe-limited deformity (two cases); C = toe and foot-limited deformity (six cases); D = toe, foot, ankle, and lower limb deformity (18 cases). Patients with slight neurologic disturbance, either Grade A or without urinary disturbance, were seen among the patients who had undergone a release operation by age 2, although neurologic appearance in patients in severe grades was not related to the age at release operation. Also, the release operation was thought to be effective in preventing low-back pain or sciatica.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Eighty-five consecutive patients with various spinal disorders who underwent surgery using the Cotrel-Dubousset pedicle screw system at Kantoh Rosai Hospital between August 1986 and November 1989 were studied. The group included 52 men and 33 women, ranging in age from 19 to 76 years, with an average age of 53 years. The postoperative follow-up period was from 15 to 54 months, with an average of 33 months. The diagnoses were lumbar degenerative disorders in 69 cases (spondylolisthesis in 32, lumbar degenerative spinal canal stenosis without spondylolisthesis in 21, and “unstable lumbar spine” in 16), spinal trauma in 9, spinal deformities in 5 (scoliosis in 3 and kyphosis in 2), and tumor in 2 (1 spinal cord tumor and 1 vertebral tumor). The Cotrel-Dubousset pedicle screw system proved not only to be useful in fixing an unstable spine from the lower thoracic vertebra to the sacrum, as is the case with the other pedicle screw systems, but also to have great advantages for use in various spinal disorders, including reduction of slipped vertebra, correction of spinal deformity combined with a hook system, and for anterior spinal instrumentation. Postoperative clinical results were good in most of the cases, but pseudarthrosis considerably affected the results in a few cases. Therefore, great care must be taken, both strategically and technically, to prevent pseudarthrosis.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID