Neurological manifestations of thoracic myelopathy

Takenaka, Shota; Kaito, Takashi; Hosono, Noboru; Miwa, Toshitada; Oda, Takenori; Okuda, Shujiro; Yamashita, Tomoya; Oshima, Kazuya; Ariga, Kenta; Asano, Masatoshi; Fuchiya, Tsuyoshi; Kuroda, Yusuke; Nagamoto, Yukitaka; Makino, Takahiro; Yamazaki, Risa; Yonenobu, Kazuo

doi:10.1007/s00402-014-2000-1

Cited by 30 publications

(37 citation statements)

References 15 publications

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“…Diagnosis of thoracic myelopathy tends to be delayed because of its complex neurological manifestations and rarity. 2 Increased lower extremities muscle tone and deep tendon reflexes, and presence of pathological reflexes indicate myelopathy. However, these are more frequently recognised in, and associated with, cervical myelopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis of thoracic myelopathy was established on clinical symptoms, physical examination, and imaging studies. Relevant clinical features included tightness around the trunk, numbness and sensory deficitis in the lower extremities, weakness in the lower extremities, altered proprioceptive sensation, 2,10 gait disturbance, and sphincter dysfunction. Other positive physical examinations consisted of increased lower extremities muscle tone and deep tendon reflexes, and presence of pathological reflexes.…”

Section: Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Outcomes of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum in a Regional Hospital: A Primitive Report and Literature Review

Eleanor

Kin

2016

Journal of Orthopaedics, Trauma and Rehabilitation

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Introduction: Symptomatic thoracic stenosis is an uncommon disease in contrast to cervical and lumbar stenosis. It has been reported that ossification of ligamentum flavum (OLF) is the most common cause of thoracic myelopathy in our locality. Materials and methods: All patients with symptomatic thoracic spinal stenosis secondary to OLF who underwent operative treatment in our institution between January 1999 and December 2013 were retrospectively reviewed for demographic data, causes, complications and surgical outcomes. Results: Twenty-six patients who underwent surgical treatment for symptomatic OLF were followed up for an average period of 71.3 months. All patients received decompression with concomitant instrumented fusion in 2 patients (7.7%). In our series, we had 2 cases (7.7%) of early post-operative neurological deterioration secondary to haematoma formation. Four cases (15.4%) were complicated with cerebrospinal fluid leakage. Operative outcome was reported in Frankel classification and modified Japanese Orthopedic Association (JOA) scale for thoracic myelopathy. After operation, 8 patients (30.8%) showed improvement in their Frankel grade, while 16 patients (61.5%) had no change and 2 patients (7.7%) reported deterioration. Mean JOA score showed significant improvement from 5.1 (range 2e8) to 6.9 post-operatively (range 2e11). Discussion and conclusion: OLF is the most common cause of thoracic myelopathy in our locality. Early accurate diagnosis and adequate surgical decompression are important for favourable outcomes despite operative difficulties and possible complications.

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Surgical Outcomes of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum in a Regional Hospital: A Primitive Report and Literature Review

Eleanor

Kin

2016

Journal of Orthopaedics, Trauma and Rehabilitation

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“…Analysis of myelopathic gait can be found for patients with cervical myelopathy due to cervical spondylosis and/or OPLL who were able to autonomously ambulate before and after decompression surgery (27). Compared with cervical myelopathy, neurological deterioration in thoracic myelopathy is rather concentrated in the lower limbs: lower limb numbness and weakness and an unsteady gait (28). Post-operative motor paralysis was observed in more than 30% of thoracic patients who underwent surgery for OPLL, more than 20% of whom underwent additional surgery to achieve recovery (29).…”

Section: Introductionmentioning

confidence: 99%

Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report

et al. 2020

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Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.

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“…TOLF can cause compression of corresponding spinal cord segments, numbness, and weakness in both lower limbs, abnormal gait, dyskinesia, sphincter dysfunction, and lower limb paraplegia. 1,2 With the popularization of large-scale imaging equipment and a deeper understanding of the disease, the number of clinical reports into TOLF has increased. [1][2][3][4] Epidemiological studies have shown that it is particularly prevalent in the Asian population.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 With the popularization of large-scale imaging equipment and a deeper understanding of the disease, the number of clinical reports into TOLF has increased. [1][2][3][4] Epidemiological studies have shown that it is particularly prevalent in the Asian population. 3,4 Conservative treatment is usually ineffective for TOLF, so surgical treatment is widely accepted as the best approach.…”

Section: Introductionmentioning

confidence: 99%

<p>Subsection Laminectomy with Pedicle Screw Fixation to Treat Thoracic Ossification of Ligamentum Flavum: A Comparative Analysis with Lamina Osteotomy and the Replantation Technique</p>

Zhang¹,

Tao²,

Yang³

et al. 2020

TCRM

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Background: There are many surgical procedures that can be used to relieve compression caused by thoracic ossification of the ligamentum flavum (TOLF). The present study aims to retrospectively observe the differences in subsection laminectomy with pedicle screw fixation (SLPF) and lamina osteotomy and replantation with miniplate fixation (LORF) in the treatment of continuous TOLF. Patients and Methods: From March 2014 to October 2017, 61 patients with continuous TOLF underwent SLPF (group A) or LORF (group B). The surgical duration, intraoperative blood loss, change in thoracic kyphosis, and perioperative complications were analyzed. Neurological function was evaluated in accordance with the Japanese Orthopedic Association (JOA) score and the American Spinal Injury Association (ASIA) neurological grading. Results: The surgical duration, intraoperative blood loss, and postoperative bed-rest duration in group A were significantly lower than those observed in group B (P < 0.05). Both groups demonstrated a significant improvement in JOA score and ASIA grade (P < 0.05). The neurological recovery rate was 69.8% ± 13.5% in group A and 68.5% ± 12.7% in group B (P > 0.05). There was also a significant improvement in ASIA grade at the final follow-up (P < 0.05). During follow-up, the Cobb angle was significantly increased in group B (P < 0.05), whereas no significant difference was observed in group A (P > 0.05). The occurrence rate of perioperative complications was 15.6% (5/32 patients) in group A and 37.9% (11/29 patients) in group B (P < 0.05). Conclusion: Both SLPF and LORF significantly promote recovery of neurological function. SLPF has a shorter surgical duration, less intraoperative blood loss, and a lower complication rate. SLPF is more conducive to the correction of sagittal sequence and maintenance of thoracic stability.

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Neurological manifestations of thoracic myelopathy

Abstract: This study elucidated symptoms specific to anatomical pathology or compressed segments in thoracic myelopathy. These relationships can be helpful in the initial investigation of thoracic diseases, although additional measures such as MRI or CT are necessary for definitive diagnosis.

Cited by 30 publications

References 15 publications

Surgical Outcomes of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum in a Regional Hospital: A Primitive Report and Literature Review

Surgical Outcomes of Thoracic Myelopathy Secondary to Ossification of Ligamentum Flavum in a Regional Hospital: A Primitive Report and Literature Review

Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report

<p>Subsection Laminectomy with Pedicle Screw Fixation to Treat Thoracic Ossification of Ligamentum Flavum: A Comparative Analysis with Lamina Osteotomy and the Replantation Technique</p>

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