Compression Médullaire Thoracique par Ossification du Ligament Jaune chez le Noir Africain

Léon Boukassa, D Massamba Miabaou, HB Ekouélé-Mbaki, OB Ngackosso, S Kinata Bambino, AS Ngounda Monianga

Abstract


RÉSUMÉ
L’ossification du ligament jaune (OLJ) est une cause de myélopathie thoracique fréquente en Asie, notamment au Japon, mais elle est de plus en plus décrite dans d’autres régions du monde. Les cas rapportés chez les sujets noirs sont encore plus rares. Nous en rapportons deux cas diagnostiqués chez deux de nos patients. Il s’agit de deux hommes âgés de 49 et 54 ans sans antécédents pathologiques particuliers qui présentaient respectivement depuis 05 et 06 ans un syndrome de compression médullaire thoracique de niveau T9 pour le premier et T4 pour le deuxième. L’atteinte motrice en proximal et distale était estimée à 1/5 pour le premier et 3/5 pour le deuxième. Le scanner et l’IRM du rachis thoracique montré des lésions aux niveaux T7- T8 et T8-T9 pour le premier et aux niveaux T3-T4 à T9-T10 pour le deuxième. Les deux patients ont bénéficié d’une laminectomie avec ablation du tissu osseux compressif. L’évolution post opératoire à un an était marquée par une lente récupération motrice. Ceci est en accord avec les données de la littérature qui conditionnent les bons résultats postopératoires au diagnostic précoce, au traitement chirurgical rapide et à l’absence de lésion médullaire en regard de la compression à l’IRM.
ABSTRACT
Ossification of the yellow ligament (OYL) is a common cause of thoracic myelopathies in Asia, particularly in Japan, but it may be found in the other continents. However, for unknown reasons, its occurrence in black Africans is rare. We report two cases of OJL occurring in two male black Africans, aged of 49 and 54 years. They had a clinical presentation of chronic spinal cord compression at a level T9 for the first and T4 for the second. Proximal and distal motor impairment was estimated at 1/5 for the first and 3/5 for the second. Thoraci MRI scan showed lesions of T7-T8 and T8-T9 for the first and from T3-T4 to T9-T10 for the second. Both patients had laminectomy and ablation of the compressive bone tissue. Post operative course at one year was marked by a stationary neurologic status for the first and slow motor recovery 4/5 for the first. This is in agreement with what is found in the literature where good post operative results requires early diagnosis, rapid surgical treatment and absence of MRI cord hypersignal in the affected zone.


Keywords


Compression médullaire, Rachis thoracique, Ossification ligament jaune

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References


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