Cervical Myelopathy by C1 Posterior Tubercle Impingement in a Patient With DISH

Abstract

This is the first report of unique C1 posterior tubercle impingement and myelopathy caused by DISH. We should keep it in mind that DISH can cause serious problems in the upper cervical spine even after 25 years of interval.

Simultaneous ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum causing upper thoracic myelopathy in DISH: case report and literature review

“…a OALL at C2-C7, b OPLL (black arrow) and OLF (white arrow) at T1-2, c no sacroiliac erosion characterized by ligamentous ossification of the anterolateral side of the spine, sparing the disc and joint space [1][2][3][4]. Although typically asymptomatic, DISH has been associated with neurological problems [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (Table 2), of which the reported rate is 4% [21]. DISH alone can cause spinal cord compression, mostly in the upper cervical spine.…”

“…DISH alone can cause spinal cord compression, mostly in the upper cervical spine. The common pathology includes retroodontoid masses [6][7][8], atlantoaxial pseudoarthrosis [9], basilar impression combined with dens hypertrophy [10], and atlantoaxial subluxation [13,14]. Fusion of the subaxial cervical spine associated with DISH was reported to result in greater stress to the ligaments of the still-mobile occipitoatlantoaxial segment, causing partial tears of the ligaments.…”

“…Fusion of the subaxial cervical spine associated with DISH was reported to result in greater stress to the ligaments of the still-mobile occipitoatlantoaxial segment, causing partial tears of the ligaments. Cycles of injury and reparative process or reactive hypertrophy contributed to the formation of this compressive pathology and subsequent neurological deterioration [6,8,14,22]. In such cases, surgical management is helpful in stopping neurological deterioration.…”

“…In such cases, surgical management is helpful in stopping neurological deterioration. Several procedures, such as transoral decompression combined with posterior fusion [6,8,10,13], decompression by the lateral approach with occipitocervical fusion [7], and single posterior decompression without fusion [9,14], have produced good clinical outcomes. In our opinion, posterior fusion may be mandatory because single decompression may aggravate the instability of the upper cervical spine, thereby leading to neurological deterioration [8].…”

Myelopathy Due to Multilevel Cervical Canal Stenosis With Forestier Disease -Case Report-

“…The neurological deficit is attributable to myelopathy in the lower cervical spine 4) associated with stenosis of the spinal canal. Reported cases of FD in the craniocervical junction are very rare, 9) and are associated with either AAD or myelopathy caused by posterior compression due to pseudoarthrosis between the posterior tubercle of the atlas and spinous process of the axis. 7) Only three cases of myelopathy were caused by AAD 2,7,10) and one of basilar impression 11) related to FD.…”