脊椎ジャーナル

Background: To report a case with melorheostosis in the spine associated with scoliosis deformity. To the best of our knowledge, there was no reported case about melorheostosis causing spinal deformities in recent literature.

Methods: This report reviewed the patient`s medical record, her imaging studies and related literature

Results: A 13-year-old male patient was taken to an orthopaedic clinic by his family three years ago due to low back pain. Patient diagnosed with scoliosis as a result of direct examination and radiographs. When the patient applied to our clinic he was taking analgesic for his pain. The patient was reported frequent episodes of back pain in recent times. He became unable to continue to play his routinely sportive activities. His family was very disturbed and anxious. Spine radiographs showed a slight scoliosis from the T4 level to the T10 level. CT scan demonstrated abnormalities of both bone density and contour in the lumbar spine. Lesions of melorheostosis were consistent with the hyperostosis seen on the CT images. We found melorheostosis causing scoliosis in the patient. We offered detailed information about melorheostosis to the patient and family. Analgesics were regulated and follow-up plans were drawn. The family was very relieved.

Conclusion: Melorheostosis is a rare mesodermal disease and one of the developmental diseases of bone density. The majority of cases describe skeletal abnormalities confined to a single limb, most predominantly the lower extremity. Involvement of and limitation of melorheostosis to the spine is rare. There was no reported case about melorheostosis causing scoliosis in recent literature. Spine surgeons should be alert in terms of pathologies, such as melorheostosis which may cause painful deformities of the spine.

Objective: To assess the feasibility of anterior cervical procedures in the treatment of C5 palsy occurring after posterior cervical decompression procedures done for the treatment of cervical spondylotic myelopathy.

Introduction: In this study we hypothesized that anterior cervical decompression would benefit these patients through widening the cervical foramen, directly by rongeurs and drills and indirectly by placing an intervertebral spacer (cervical cage). The aim of the study is to assess whether a more proactive approach would benefit these patients.

Materials and methods: Between January 2005 and September 2011, 200 posterior cervical procedures have been done by the authors, for the treatment of cervical spondylotic myelopathy (CSM). The procedures done were laminectomy with or without instrumentation. Forty cases developed C5 palsy postoperatively (20%). 20 cases (50%) presented immediate postoperatively and the rest presented during the first week postoperatively. All the cases started a course of conservative treatment of steroids, analgesics and physiotherapy. Thirty patients (75%) improved on conservative treatment. Ten patients did not improve after more than one year of conservative management. Two cases had a single level anterior cervical discectomy and cage fusion (ACDF), 3 cases had single level ACDF with
plate fixation and 3 cases had 2 levels ACDF with plate fixation. Two cases had 3 levels ACDF with interbody fusion and plate fixation. The operative choice was made in order to increase the lordotic curve and the foraminal diameter.

Results: Immediately postoperatively all patients had improved radicular pain. Assessment of the motor power was made immediately postoperative and 3 months afterwards with continuous physiotherapy. There was no change in the C5 palsy in all cases on the immediate postoperative examination, whereas all cases showed improvement of at least 2 grades in the 3 months postoperative visits. All patients at the final follow up had an MMT (Manual Muscle Test) grade of at least 3. Six patients reached an MMT grade of 4 or more. One case had recurrent myelopathy 9 months after 3 levels ACDF and fixation. His MRI showed adjacent segment degeneration at a higher level and had led to myelopathy. He improved on conservative treatment. Two cases died during follow up period: one at 10 months postoperatively from complications of massive myocardial infarction and the other one 15 months postoperatively from
bronchogenic carcinoma diagnosed 7 months after surgery.

Conclusion: Postoperative C5 palsy following posterior decompression for cervical spondylotic myelopathy is not an uncommon occurrence and the majority of cases will respond to conservative treatment. Anterior decompression procedures may offer a safe and effective solution for those few patients who do not respond to a prolonged period of conservative management.

Study design: A case-control study using radiograph findings and the PCR assay with regard to the susceptibility and the severity of ossification of posterior longitudinal ligament of the spine (OPLL).

Objective: To analyze whether the single nucleotide polymorphisms in the Bone Morphogenetic Protein Receptor IA (BMPIA) gene predisposed to increased the frequency and severity of OPLL.

Methods: Analysis of 292 OPLL patients and 586 non-OPLL controls was performed. Radiographs of the cervical spine were analyzed to determine whether OPLL was present and to what degree. Genomic DNA was extracted from all participants. Polymorphisms of the BMPRIA gene were analyzed using the PCR assay. The association of the polymorphisms with the development and extent of OPLL were statistically evaluated.

Results: Significant associations were found between two single nucleotide polymorphisms (rs34755052, rs11528010) and the existence of OPLL in BMPRIA genes. Both of rs34755052 (C/T) and rs11528010 (C/A) were more frequent in patients with OPLL. Regarding the rs11528010 (C/A), patient with A Allele had a significantly greater number of ossified cervical vertebrae compared with patients without the A allele, but rs34755052 didn’t show the similar tendency.

Conclusion: The present results suggested that rs34755052(C/T) was associated with the occurrence of OPLL, but not associated with the severity of OPLL. rs11528010(C/A) was associated with more extensive OPLL and the frequency with which it occured.

“Schmorl’s nodes” (SN) are lytic lesions at endplates which are believed to be due to the herniation of the nucleus pulposus through the cartilaginous endplate into the body of a vertebral endplates. Our observations disclose the fact that all Schmorl’s nodes are not single entities and a subset of SNs seems to be a discrete clinical condition with similar (but not identical) imaging manifestations. They share many features of seronegative spondyloarthritis. We called them “Owlia’s nodes”.