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Query: UMLS:C0851184 (thinning)
 11,252 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic compressive myelopathy was induced in domestic rabbits by implanting bone morphogenetic protein on the ligamentum flavum of the lumbar spine, and the resulting spinal cord lesion was studied histopathologically. In addition, morphometry of myelinated nerve fibers of the white matter in the pathologic specimens was performed to elucidate the mechanisms of cord injury. No loss of white matter nerve fibers was seen when the cord compression ratio (sagittal diameter/transverse diameter) was > 45%, although 6 months later myelin thinning was present throughout the white matter. When the cord compression ratio was < or = 45%, loss of fibers, particularly of large fibers, was seen in the superficial layer of the white matter, with the nerve fibers remaining after 6 months showing decreased diameters. No motor paresis was evident in any animal. These histologic changes represent the early pathologic condition induced by chronic cord compression.
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PMID:Histopathologic and morphometric study of spinal cord lesion in a chronic cord compression model using bone morphogenetic protein in rabbits. 146 13

We report a 72-year-old patient with thoracic myelopathy due to isolated ossification of the ligamentum flavum at T9-T10. Severe paraparesis had developed before the lesion was identified when thinning of a segment of the lower thoracic spinal cord was suspected on a second MRI examination. The diagnosis was then established by CT.
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PMID:Thoracic myelopathy due to isolated ossification of the ligamentum flavum. 782 70

We reported a peculiar case of a patient with a thoracic extradural cyst, who had a 30-year history of thoracic-myelopathy with a very long-term remission. A 42-year-old male was admitted to our hospital complaining of gait disturbance and hypesthesia of his bilateral lower limbs. Neurological examination revealed that he had spastic paraparesis and hypesthesia of all sensory modalities below Th11/12 dermatomes. Investigation of his past history disclosed that he had experienced gait disturbance due to paraplegia 29 years previously and had been able to move only with the aid of wheel-chairs. However these signs had resolved themselves gradually in a period of 3 years, and after that he had been able to live almost without any neurological handicaps until the recent appearance of weakness in both of his legs. Neuroradiological study revealed that plain X-Ps of the thoracic spine showed thinning of the pedicles and widening of the interpedicular distances between Th4-Th7 vertebrae. The old iodine contrast media injected 29 years previously for myelography in an other hospital was also observed. MRI showed a dorsal cystic mass compressing the thoracic spinal cord and subarachnoid space. Myelography showed also that the spinal cord and subarachnoid space were compressed anteriorly between the level of Th3 to Th7 by the dorsal mass. CT myelography disclosed that soon after the injection of contrast media a small part of the cyst was visualized as having direct communication with the subarachnoid space. The contrast media penetrated the major part of the cyst only 19 hours after its injection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Congenital extradural cyst causing a 30-year history of myelopathy with long-term remission]. 832 3

Ossification of the posterior longitudinal ligament lessens the sagittal diameter of the cervical canal and compresses the spinal cord anteriorly, and may produce severe disabling myelopathy. The anterior floating method is one of the anterior decompression and reconstructions used in the treatment of cervical myelopathy caused by ossification of the posterior longitudinal ligament. This procedure consists of subtotal resection of vertebral bodies and discs, with slight thinning and release of the ossified ligament using air instrumentation. This is followed by reconstruction of the cervical spine using autogenous strut bone graft accompanied by postoperative application of a halo vest. This method is indicated for patients who present with moderate or severe myelopathies, and especially in those where the canal narrowing ratio exceeds 60%. This radical procedure causes decompression of the spinal cord and restores its function by enlarging the neural canal with anterior migration of the ossified ligament. The procedure minimizes the extent of surgical invasions and avoids damage to the neural tissue, because it does not require the removal of the ossification of the posterior longitudinal ligament. It also stops postoperative regrowth of the ossification. The operative results with long term followup indicate a 71% average recovery rate based on the criteria established by the Japan Orthopedic Association.
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PMID:Anterior floating method for cervical myelopathy caused by ossification of the posterior longitudinal ligament. 1007 26

We retrospectively reviewed acute cervical cord injury after minor trauma in 10 patients with os odontoideum. Their clinical history, neurological symptoms, radiological investigations, follow-up period, American Spinal Injury Association impairment classification and motor score were reviewed. Before their traumatic injury, three patients were asymptomatic and seven reported myelopathic symptoms, including four patients with neck pain, two patients with unsteadiness and one patient with dizziness. Falls were the most common cause of injury (n=6), followed by minor motor vehicle accidents (n=3) and assault (n=1). MRI and dynamic cervical lateral radiographs showed that all patients had atlantoaxial instability and cord compression. Most patients had spinal cord thinning and hyperintensity on T2-weighted MRI. Spinal cord compression was posterior (n=5), or both anterior and posterior (n=5). All patients underwent posterior rigid screw fixation and fusion, including atlantoaxial fusion (n=8) and occipitocervical fusion (n=2). We conclude that patients with asymptomatic or myelopathic atlantoaxial instability secondary to os odontoideum are at risk for acute spinal cord injury after minor traumatic injury. Fixation and fusion should be undertaken as prophylactic treatment for patients at risk of developing myelopathy and to avoid the neurological deterioration associated with acute traumatic cervical cord injury.
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PMID:Acute traumatic cervical cord injury in patients with os odontoideum. 2065 29

OBJECTIVE Although posterior decompressive surgery is widely used to treat patients with cervical myelopathy and multilevel ossification of the posterior longitudinal ligament (OPLL), a poor outcome is anticipated if the sagittal alignment is kyphotic (or K-line negative). Accordingly, it is mandatory to perform anterior decompression and fusion in patients with cervical kyphosis. However, it can be difficult to perform anterior surgery because of the high risk of complications. This present report proposes a novel "greenstick fracture technique" to change the K-line from negative to positive in patients with cervical myelopathy, OPLL, and kyphotic deformity. METHODS Four patients with cervical myelopathy, continuous-type OPLL, and kyphotic sagittal alignment (who were K-line negative) were indicated for surgery. Posterior laminectomy and lateral mass screw insertions using a posterior approach were performed, followed by anterior surgery. Multilevel discectomy and thinning of the OPLL mass by bur drilling was performed, then an intentional greenstick fracture at each disc level was made to convert the cervical K-line from negative to positive. Finally, posterior instrumentation using a rod was carried out to maintain cervical lordosis. RESULTS MRI showed complete decompression of the cord by posterior migration in all cases, which had been caused by cervical lordosis. Restoration of neurological defects was confirmed at the 1-year follow-up assessment. No specific complications were identified that were associated with this technique. CONCLUSIONS A greenstick fracture technique may be effective and safe when applied to patients with cervical myelopathy, continuous-type OPLL, and kyphotic deformity (K-line negative). However, further studies with more cases will be required to reveal its generalizability and safety.
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PMID:A novel technique to correct kyphosis in cervical myelopathy due to continuous-type ossification of the posterior longitudinal ligament. 2779 29

Thoracic disc prolapses causing cord compression can be challenging. For compressive central disc protrusions, a posterior approach is not suitable due to an unacceptable level of cord manipulation. An anterolateral transthoracic approach provides direct access to the disc prolapse allowing for decompression without disturbing the spinal cord. In this video, we describe 2 cases of thoracic myelopathy from a compressive central thoracic disc prolapse. In both cases, informed consent was obtained. Despite similar radiological appearances of heavy calcification, intraoperatively significant differences can be encountered. We demonstrate different surgical strategies depending on the consistency of the disc and the adherence to the thecal sac. With adequate exposure and detachment from adjacent vertebral bodies, soft discs can be, in most instances, separated from the theca with minimal cord manipulation. On the other hand, largely calcified discs often present a significantly greater challenge and require thinning the disc capsule before removal. In cases with significant adherence to dura, in order to prevent cord injury or cerebrospinal fluid leak a thinned shell can be left, providing total detachment from adjacent vertebrae can be achieved. Postoperatively, the first patient, with a significantly calcified disc, developed a transient left leg weakness which recovered by 3-month follow-up. This video outlines the anatomical considerations and operative steps for a transthoracic approach to a central disc prolapse, whilst demonstrating that computed tomography appearances are not always indicative of potential operative difficulties.
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PMID:Anterolateral Approach for Central Thoracic Disc Prolapse-Surgical Strategies Used to Tackle Differing Operative Findings: 3-Dimensional Operative Video. 2961 73