Iatrogenic Spinal Cord Injury during Removal of the Inferior Articular Process in the Presence of Ossification of the Ligamentum Flavum

Burke, Shane M.; Hwang, Steven W.; Safain, Mina G.; Riesenburger, Ron I.

doi:10.1155/2016/2318759

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…In this research, we analyzed the IAPCSA from LS-MRI images and visualized IAP in transverse T1-weighted LS-MRI. LS-MRI provides a high-quality view of the IAP and IAP hypertrophic changes [10,21]. Our research had a few weaknesses.…”

Section: Discussionmentioning

confidence: 98%

“…Because the inferior articular facet meets the superior articular facet at the posterior and medial concavity of the adjoining surface [19], these frictions can exert continuous pressure on zygapophyseal joints and alter morphological features of IAP, leading to a high degree of abrasion [20]. Burke et al have reported a case of spinal cord trauma caused by direct transmission of force from an ostectomy to a symptomatic ossified ligamentum flavum during resection of an IAP [21]. Das et al have reported that an asymmetrical hypertrophy of IAP might be related to disc degeneration and CLSS, and that it may be a cause of buttock and low back pain [22].…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

Lee

Lim

et al. 2020

JCM

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Hypertrophy of facet joints is associated with a high risk of central lumbar spinal stenosis (CLSS). However, no research has reported the effect of inferior articular process hypertrophy in CLSS. We hypothesize that the inferior articular process’s cross-sectional area (IAPCSA) is larger in patients with CLSS compared to those without CLSS. Data on IAPCSA were obtained from 116 patients with CLSS. A total of 102 control subjects underwent lumbar spine magnetic resonance imaging (LS-MRI) as part of a routine medical examination. Axial T1-weighted images were obtained from the two groups. Using an imaging analysis system, we investigated the cross-sectional area of the inferior articular process. The average IAPCSA was 70.97 ± 13.02 mm2 in control subjects and 88.77 ± 18.52 mm2 in patients with CLSS. CLSS subjects had significantly greater levels of IAPCSA (p < 0.001) than controls. A receiver operating characteristic (ROC) curve was plotted to determine the validity of IAPCSA as a predictor of CLSS. The most suitable cut-off point of IAPCSA for predicting CLSS was 75.88 mm2, with a sensitivity of 71.6%, a specificity of 68.6%, and an area under the curve (AUC) of 0.78 (95% CI: 0.72–0.84). Greater IAPCSA levels were associated with a higher incidence of CLSS. These results demonstrate that IAPCSA is a useful morphological predictor in the evaluation of CLSS.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

Lee

Lim

et al. 2020

JCM

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Unilateral biportal endoscopic decompression for symptomatic thoracic ossification of the ligamentum flavum: a case control study

Deng

Yang

Xia

et al. 2022

International Orthopaedics (SICOT)

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The clinical effect of floating island laminectomy technique for severe thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum: a retrospective study

Zhong,

Xiu,

Chen

et al. 2024

Preprint

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Background Severe thoracic ossification of the ligamentum flavum often leads to thoracic spinal canal stenosis and spinal cord injury, which generates severe symptoms. Generally, patients required surgery and aggravated spinal cord function impairment is a common complication. We propose a novel surgical technique to remove the ossified ligamentum flavum with the adhesive dura as a floating island. The purpose of this study was to evaluate the clinical efficacy and safety of floating island in the treatment of severe ossification of ligamentum flavum. Methods A total of 31 patients with thoracic spinal stenosis and myelopathy caused by thoracic ossification of the ligamentum flavum from January 2019 to April 2022 were included in the study and were followed up at 1, 3, 6, and 12 months, respectively. All patients were treated with floating island laminectomy technique. Neurological function was assessed by the modified Japanese Orthopaedic Association (mJOA) scoring system before and after operation and the rate of improvement was calculated. Perioperative complications were also recorded in this study. Results All 31 patients were successfully completed by the same professional surgery team. The average operative time was 207.74 ± 58.54 minutes, and the average intra-operative blood loss was 406.45 ± 217.85 ml. The mJOA score at 1 month, 3 months, 6 months and 12 months after surgery increased from 4.68 ± 0.60 to 6.71 ± 0.73, 7.35 ± 0.76, 8.45 ± 0.85 and 9.06 ± 0.81, respectively. The mJOA score after surgery was significantly higher than before (P < 0.001). The recovery rate was (32.41 ± 8.55)%, (42.57 ± 9.00)%, (60.12 ± 11.07)% and (69.76 ± 11.38)% for 1 month, 3 months, 6 months and 12 months after surgery, respectively. Postoperative complications included dural tear in 13 cases (41.9%), defect in 10 cases (32.2%) and cerebrospinal fluid leakage in 10 cases (32.2%). There was no recurrence of ossification or postoperative thoracic vertebra deformity in patients with aggravated neurological injury. Conclusion The results of this study indicate that although the incidence of cerebrospinal fluid leakage is a little high after operation, the floating island laminectomy method for the treatment of thoracic ossification of the ligamentum flavum is still safe and effective, which can effectively avoid the aggravation of neurological symptoms and enable patients to obtain satisfactory neurological function improvement and functional recovery.

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Iatrogenic Spinal Cord Injury during Removal of the Inferior Articular Process in the Presence of Ossification of the Ligamentum Flavum

Cited by 4 publications

References 28 publications

Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

Usefulness of the Inferior Articular Process’s Cross-Sectional Area as a Morphological Parameter for Predicting Central Lumbar Spinal Stenosis

Unilateral biportal endoscopic decompression for symptomatic thoracic ossification of the ligamentum flavum: a case control study

The clinical effect of floating island laminectomy technique for severe thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum: a retrospective study

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