Remarkable epidural scar formation compressing the cervical cord after osteoplastic laminoplasty with hydroxyapatite spacer

Case report

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The authors report on an 81-year-old woman whose condition deteriorated 2 months after undergoing osteoplastic laminoplasty with placement of hydroxyapatite spacers. Magnetic resonance imaging showed postlaminectomy scar formation compressing the cervical spinal cord. The patient underwent laminectomy and removal of remarkably thick epidural scar tissue, which resulted in resolution of her symptoms. Histological diagnosis of the scar was fibrous granulation tissue with foreign body granuloma, characterized by multinucleated giant cells and marked increases of capillary vessels, fibroblasts, and collagen fibers. This case of symptomatic postlaminectomy scar formation after osteoplastic laminoplasty suggests that osteoplastic laminoplasty cannot always prevent laminectomy membrane formation.

Abbreviation used in this paper: JOA = Japanese Orthopaedic Association.

Article Information

Address correspondence to: Keita Kuraishi, M.D., Ph.D., Spinal Disorders Center, Fujieda Heisei Memorial Hospital, 123-1 Mizukami, Fujieda, Shizuoka 426-8662, Japan. email: kuraishikeita@yahoo.co.jp.

Please include this information when citing this paper: published online August 12, 2011; DOI: 10.3171/2011.6.SPINE10930.

© AANS, except where prohibited by US copyright law.

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Figures

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    A–C: Lateral radiographs of the cervical spine obtained before laminoplasty in flexion (A), neutral (B), and extension (C) positions, demonstrating slight kyphotic change without remarkable instability. D: Sagittal T2-weighted MR image obtained before laminoplasty showing compression of the dural tube from C3–4 to C5–6 levels and an intramedullary high-intensity area.

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    A: Lateral radiograph obtained 4 months after laminoplasty demonstrating adequate positioning of the hydroxyapatite spacers. B: Sagittal T2-weighted MR image of the cervical spine 1 month after the first operation showing decompression of the spinal cord with slight residual stenosis at the C5–6 level. C: Sagittal MR image obtained 3 months after laminoplasty demonstrating progression of cord compression.

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    A and B: Sagittal (A) and axial (B) T1-weighted MR images obtained after intravenous injection of gadolinium revealing massive epidural scar formation compressing the spinal cord. C: Axial CT images showing ideal positions of hydroxyapatite spacers without lamina subsidence or hinge fracture.

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    Intraoperative photographs obtained during the second operation showing the hydroxyapatite spacers and fibrous granulated tissue (A), casts with clear margins after removal of the spacers (B), and complete decompression (C).

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    Photomicrographs of sections from the epidural scar. A: Image showing fibrous granulation tissue with foreign body granuloma, characterized by multinucleated giant cells and marked increases of capillary vessels, fibroblasts, and collagen fibers. B: Image showing an example of the inorganic material, thought to be hydroxyapatite, that was included within the cytoplasm of the multinucleated giant cells. H & E, original magnification × 40 (A) and × 400 (B).

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    Sagittal T2-weighted MR image obtained 14 months after revision surgery demonstrating successful decompression of the spinal cord.

References

1

Hirabayashi K: [Expansive open-door laminoplasty for cervical spondylotic myelopathy.]. Shujutsu 32:115911631978. (Jpn)

2

Hirabayashi KSasaki TTakeda T: [The posterior and anterior operation in treatment of cervical disc lesion including cervical spondylosis: a long-term follow-up study.]. Chubu Nippon Seikeigeka Saigaigeka Gakkai Zasshi 15:7867881972. (Jpn)

3

Japanese Orthopaedic Association: [Scoring system for cervical myelopathy.]. Nippon Seikeigeka Gakkai Zasshi 68:4905031994. (Jpn)

4

Kaptain GJSimmons NEReplogle REPobereskin L: Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 93:2 Suppl1992042000

5

Kawai SSunago KDoi KSaika MTaguchi T: Cervical laminoplasty (Hattori's method). Procedure and follow-up results. Spine (Phila Pa 1976) 13:124512501988

6

Key JAFord LT: Experimental intervertebral-disc lesions. J Bone Joint Surg Am 30A:6216301948

7

LaRocca HMacnab I: The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg Br 56B:5455501974

8

Li DJOhsaki KIi KYe QNobuto YTenshin S: Longterm observation of subcutaneous tissue reaction to synthetic auditory ossicle (Apaceram) in rats. J Laryngol Otol 111:7027061997

9

Liu GBuchowski JMBunmaprasert TYeom JSShen HRiew KD: Revision surgery following cervical laminoplasty: etiology and treatment strategies. Spine (Phila Pa 1976) 34:276027682009

10

Oyama MHattori SMoriwaki NNitta S: [A new method of cervical laminectomy.]. Chubu Nippon Seikeigeka Saigaigeka Gakkai Zasshi 16:7927941973. (Jpn)

11

Ratliff JKCooper PR: Cervical laminoplasty: a critical review. J Neurosurg 98:3 Suppl2302382003

12

Rönnberg KLind BZoega BGadeholt-Göthlin GHalldin KGellerstedt M: Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients. Eur Spine J 17:171417202008

13

Rosner MEdward DPTso MO: Foreign-body giant-cell reaction to the hydroxyapatite orbital implant. Arch Ophthalmol 110:1731741992

14

Saitoh ATsuda YBhutto IAKitaoka TAmemiya T: Histologic study of living response to artificially synthesized hydroxyapatite implant: 1-year follow-up. Plast Reconstr Surg 98:7067101996

15

Seichi ATakeshita KOhishi IKawaguchi HAkune TAnamizu Y: Long-term results of double-door laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976) 26:4794872001

16

van der Meulen JKoerten HK: Inflammatory response and degradation of three types of calcium phosphate ceramic in a non-osseous environment. J Biomed Mater Res 28:145514631994

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