Anterior cervical locking plate-related complications; prevention and treatment recommendations. (17/57)

A retrospective study evaluating complications in 2,233 consecutive patients of subaxial cervical disorders treated with an anterior cervical locking plate was performed, and recommendations for prevention and treatment were made. The average length of follow-up was 1.3 years. Any loosening or breaking of the plates and screws or malpositions that threatened tracheoesophageal or neurovascular structures were defined as the complications. There were 239 cases (10.7%) with different kinds of complications. The complications included oblique plating in 56 cases in which the screw could irritate the nerve root. Screws were driven into the disc space in four cases, which ultimately led to plate loosening. Screws penetrated the endplate or passed excessively close to it producing a triangle fracture in 19 cases. Loosening or breaking of the plate and the screw was found in 115 cases. These phenomena were always associated with non-union. Three oesophageal perforations occurred and conservative treatments proved effective. Finally, overlong plates impinged on the adjacent level in 14 cases and promoted disc degeneration ultimately leading to revision surgery. Good training and careful operation may help to decrease the complication rate. Most hardware complications are not symptomatic and can be treated conservatively. Only a few of them need immediate reoperation.  (+info)

Tetraparesis secondary to cervical ossification of the posterior longitudinal ligament: case report. (18/57)

Ossification of the posterior longitudinal ligament (OPLL) is a rare cause of myelopathy in non-Oriental populations and relatively unrecognized by general practitioners. A case of an Afro-Brazilian 54-years-old woman presenting with tetraparesis due to cervical OPLL is presented. Emphasis is made for the inclusion of OPLL in the differential diagnosis of compressive cervical myelopathy.  (+info)

Cervical myelopathy caused by soft-tissue mass in diffuse idiopathic skeletal hyperostosis. (19/57)

A rare case of cervical spinal cord compression in diffuse idiopathic skeletal hyperostosis (DISH or Forestier's Disease) caused by a craniocervical mass of soft-tissue is reported. The objective is to describe an uncommon mechanism of spinal cord compression in DISH. Three weeks after a cardiac infarction a 69-year-old man slowly developed spastic tetraparesis. Magnetic resonance tomography showed a craniocervical tumor compressing the spinal cord and a massive DISH of the cervical spine. An extended mass of yellowish amorphous material was removed from between the dura, the posterior odontoid process and the posterior aspect of vertebral body C2 reaching to the upper part of C3.The histologic appearance indicated connective tissue and cell-degenerated cartilaginous tissue. There was no inflammatory component and no evidence of neoplasia. No ossification of the posterior longitudinal ligament (OPLL) was found. After removal and craniocervical stabilization the patient's neurologic function improved remarkably. The increase of mechanical stress on the atlantoaxial segment and enhanced proliferation reaction of the connective tissue in DISH are suggested as the underlying pathomechanisms in the formation of this soft-tissue mass.  (+info)

Possible role of extracellular nucleotides in ectopic ossification of human spinal ligaments. (20/57)

To reveal the involvement of extracellular nucleotides in the ossification process in ossification of the posterior longitudinal ligament of the spine (OPLL), the mRNA expression profiles of P2 purinoceptors, mechanical stress-induced ATP release, and ATP-stimulated expression of osteogenic genes were analyzed in ligament cells derived from the spinal ligament of OPLL patients (OPLL cells) and non-OPLL cells derived from the spinal ligaments of cervical spondylotic myelopathy patients as a control. The extracellular ATP concentrations of OPLL cells in static culture were significantly higher than those of non-OPLL cells, and this difference was diminished in the presence of ARL67156, an ecto-nuclease inhibitor. Cyclic stretch markedly increased the extracellular ATP concentrations of both cell types to almost the same level. P2Y1 purinoceptor subtypes were intensively expressed in OPLL cells, but only weakly expressed in non-OPLL cells. Not only ATP addition but also cyclic stretch raised the mRNA levels of alkaline phosphatase and osteopontin in OPLL cells, which were blocked by MRS2179, a selective P2Y1 antagonist. These increases in the expression of osteogenic genes were not observed in non-OPLL cells. These results suggest an important role of P2Y1 and extracellular ATP in the progression of OPLL stimulated by mechanical stress.  (+info)

A functional RNAi screen for Runx2-regulated genes associated with ectopic bone formation in human spinal ligaments. (21/57)

Ossification of the posterior longitudinal ligament of the spine (OPLL) is characterized by ectopic ossification in the spinal ligaments, which enlarges with time and compresses the spinal cord, resulting in serious neurological symptoms. We previously reported that Runx2 expression was enhanced in spinal ligament cells from OPLL patients (OPLL cells). To clarify genes regulated by Runx2, Runx2 expression was first enhanced by culturing primary OPLL cells in osteogenic medium (OS induction) and then inhibited by siRNAs targeted to Runx2. DNA microarray demonstrated that in addition to chondrogenic factors such as connective tissue growth factor and cartilage oligomeric matrix protein, angiopoietin-1 was also significantly increased by OS induction and decreased by siRNAs for Runx2 in OPLL cells, suggesting that these genes are regulated by Runx2. However, these changes were not observed in non-OPLL control cells (from cervical spondylotic myelopathy patients). Furthermore, Runx2 was not decreased by siRNAs for angiopoietin-1. OS induction and RNAi inhibition of angiopoietin-1 expression was also observed in osteoblasts. Both siRNAs for Runx2 and angiopoietin-1 completely inhibited aggrecan-1 expression. These results suggest that angiopoietin-1 is downstream of Runx2 in both OPLL primary cells and osteoblasts. Angiopoietin-1 may play an important role in ectopic ossification.  (+info)

Association of bone morphogenetic protein-2 gene polymorphisms with susceptibility to ossification of the posterior longitudinal ligament of the spine and its severity in Chinese patients. (22/57)

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Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine. (23/57)

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Long-term outcome of laminectomy and instrumented fusion for cervical ossification of the posterior longitudinal ligament. (24/57)

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