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Isao Hashimoto and Yoon-Kil Tak

:10.5, C-6:11.0; ossification of posterior longitudinal ligament C2-5 no filling of subarachnoid space from C2-7 laminectomy C-1 to T-2 excellent recovery of function; returned to full work 4 59 M flaccid tetraplegia; loss of sensation below C-5 dermatome following hyperextension injury C-1:20.5, C-2:18.0, C-3:15.0, C-4:10.0, C-5:11.5, C-6:13.0; fusion of cervical vertebrae at C2-3 obliteration of subarachnoid space C3-7 laminectomy from C-2 to T-1 good recovery of motor & sensory function Discussion Comparison of the results

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Chikao Nagashima, Motohide Takahama, Toshikatsu Shibata, Hiroaki Nakamura, Keiichi Okada, Hitoshi Morita and Hirokazu Kubo

four limbs on hyperextending neck, marked impaired vibration sense below T-4, spastic gait 65, F (Case 3) C3–4, oval dns OPLL in C-5, moderate cervical spondylosis moderate DM, chronic hepatitis CPPD spastic tetraparesis, loss of all sensory modalities below C-5, flaccid neurogenic bladder, diabetic polyneuritis & retinopathy * Abbreviations: dns = densities; DM = diabetes mellitus; OPLL = ossification of posterior longitudinal ligament; hd = high density; CPPD = calcium pyrophosphate dihydrate; CT = computerized tomography

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Toshihiko Kubota, Kazuhumi Sato, Hirokazu Kawano, Shinjiro Yamamoto, Asao Hirano and Yoshio Hashizume

✓ A case of ossification of the cervical posterior longitudinal ligament was investigated with the electron microscope. The posterior longitudinal ligament was composed of bundles of collagen fibers intermingled with occasional fibroblasts and rare blood vessels. Some ligaments contained matrix vesicles in the vicinity of degenerated cells. Hydroxyapatite crystals were frequently precipitated within the matrix vesicles. These findings are similar to the fine structure of the early stage of calcification in normal and pathological calcifying tissues described previously. In this study, the calcification process of the posterior longitudinal ligament suggests that matrix vesicles originate from degenerated cells, and acquire hydroxyapatite crystal deposits. Some eventually coalesce to form a large calcifying mass. Substantial amounts of collagen fibers comprising the ligament may serve an important role in orienting apatite crystal precipitation.

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Kazuo Yonenobu, Sohei Ebara, Keiju Fujiwara, Kazuo Yamashita, Keiro Ono, Tomio Yamamoto, Norimasa Harada, Hiroshi Ogino and Shinzaburo Ojima

, the results of anterior surgery seem to be more favorable than those of laminectomy, and spinal stability is restored at the same time. The extent of the decompression by this procedure is, however, limited to three vertebral segments. References 1. Firooznia H , Benjamin VM , Pinto RS , et al : Calcification and ossification of posterior longitudinal ligament of spine. Its role in secondary narrowing of spinal canal and cord compression. NY State J Med 82 : 1192 – 1198 , 1982 Firooznia H, Benjamin VM, Pinto RS

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Griffith R. Harsh IV, George W. Sypert, Philip R. Weinstein, Donald A. Ross and Charles B. Wilson

-CT scanning. J Neurosurg 61: 281–289, 1984 5. Correa AV , Beasley BAL : Ossification of posterior longitudinal ligament. NY State J Med 80 : 1972 – 1974 , 1980 Correa AV, Beasley BAL: Ossification of posterior longitudinal ligament. NY State J Med 80: 1972–1974, 1980 6. Crandall PH , Gregorius FK : Long term follow-up of surgical treatment of cervical spondylotic myelopathy. Spine 2 : 139 – 146 , 1977 Crandall PH, Gregorius FK: Long term follow-up of surgical treatment of cervical

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Izumi Koyanagi, Yoshinobu Iwasaki, Kazutoshi Hida, Hiroyuki Imamura and Hiroshi Abe

preoperative T 2 *-weighted images was demonstrated in 12 of the 24 patients. The intramedullary hyperintensity was still observed on postoperative T 2 *-weighted images in 11 of these 12 patients, although all of these patients showed neurological improvement after surgery. Discussion Ossification of Posterior Longitudinal Ligament and Disc Protrusion Magnetic resonance imaging findings of cervical OPLL have been reported by several authors. 18, 24, 26, 29, 31 Magnetic resonance T 1 - and T 2 -weighted images have demonstrated ossified ligaments with

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Mohammed A. Eleraky, Carlos Llanos and Volker K. H. Sonntag

Object. This study was conducted to determine the indications, safety, efficacy, and complication rate associated with performing corpectomy to achieve anterior decompression of neural elements or for removing anterior lesions.

Methods. Between 1987 and 1998, 185 patients underwent cervical corpectomy for the treatment of degenerative spondylitic disease (81 cases), ossification of posterior longitudinal ligament (16 cases), correction of postoperative kyphosis (31 cases), trauma (39 cases), tumor (10 cases), and infection (eight cases). Ninety-nine patients presented with myelopathy, 48 with radiculomyelopathy, 24 with radicular pain, and 14 with neck muscle pain. Eighty-seven patients underwent a one-level corpectomy; 45 of these patients underwent a discectomy at a different level. Seventy patients underwent a two-level corpectomy; 27 of these patients underwent a discectomy at a different level. Twenty-eight patients underwent a three-level corpectomy. Autograft (iliac crest) was used in 141 cases and allograft (fibula) in 44 cases. All but six patients underwent fixation with an anterior plate-screw system. There were no operative deaths. During the procedure the vertebral artery was injured in four patients and preserved in two of them. No neurological sequelae were encountered. Postoperative hoarseness, transient dysphagia, and pain at the graft site were transitory and successfully managed. The fusion rate was 98.8%. Six patients experienced transient deterioration after surgery but they improved. No patient experienced permanent neurological deterioration and 160 (86.5%) improved.

Conclusions. Corpectomy has an important role in the management of various degenerative, traumatic, neoplastic, or infectious disorders of cervical spine. Following treatment in this series, radiculopathy always improved and myelopathy was reversed in most patients.

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Yohei Hidai, Sohei Ebara, Mikio Kamimura, Yutaka Tateiwa, Hidehiro Itoh, Tetsuya Kinoshita, Kunio Takaoka and Kuniyoshi Ohtsuka

51 mm 2 . Postoperatively the patient's hand clumsiness and gait disturbance were completely resolved. His postoperative JOA score was 17, and his recovery rate was 100% ( Fig. 5 ). Fig. 5. Case 2. Computerized tomography myelography scans obtained in a 74-year-old man with cervical ossification of posterior longitudinal ligament. Upper: Preoperative scans of the C-3 level (left) and C-4 level (right). Lower Left and Right: Scans obtained 1 month after surgery. Case 3 This 71-year-old man began experiencing numbness and paresthesias of

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Cheng-Chih Liao and Shih-Tseng Lee

decompression for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg 55 : 108 – 116 , 1981 Abe H, Tsuru M, Ito T, et al: Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg 55: 108–116, 1981 2. Epstein NE : Cervical ossification of posterior longitudinal ligament , in Wilkins RH , Rengachary SS (eds): Neurosurgery , ed 2 . New York : McGraw-Hill , 1996 , Vol 3 , pp 3781 – 3787 Epstein NE: Cervical

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Takeo Goto, Kenji Ohata, Toshihiro Takami, Misao Nishikawa, Naohiro Tsuyuguchi, Michiharu Morino, Yasuhiro Matusaka, Akimasa Nishio, Yuichi Inoue and Mitsuhiro Hara

in Case 3 (upper row) and Case 18 (lower row) . The studies shown are (from left to right) preoperative, immediate postoperative, 6-month follow-up, and 12-month follow-up scans, respectively. Upper Row: A preoperative axial CT scan revealed developmental stenosis of the spinal canal associated with osteophytic spur on the left side. Follow-up axial CT scans obtained at the level of C-4 after expansive laminoplasty in a case of cervical stenotic myelopathy with ossification of posterior longitudinal ligament. An HA spacer of medium size was inserted on the