Article Sidebar
Main Article Content
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.
Article Details
References
- Akhaddar A, Mansour A, Zrara I, Gazzaz M, Maftah M, Mostarchid B, Benomar S, Boucetta M. Compression médullaire thoracique secondaire à une ossification des ligaments jaunes. Rev Rhum 2002 ; 69 :548-52.
- Nishiura I, Isozuni T, Nishihara K, Handa H, Koyoma T. Surgical approach to ossification of the thoracic yellow ligament. Surg Neurol 1999 ; 283-372.
- Hamouda KB, Jemel H, Haouet S, Khaldi M. Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases. Journal of Neurosurgery: Spine 2003; 99: 157-161.
- Ahn DK, Lee S, Moon SH, Boo KH, Chang BK, Lee JI. Ossification of the ligamentum flavum. Asian spine journal 2014 ; 8 : 89-96.
- Yabe Y, Honda M, Hagiwara Y, Tohjo Y, Nakajima S, Ando A, Sonofuchi K, Itoi E. Thoracic radiculopathy caused by ossification of the ligamentum flavum. Upsala journal of medical sciences 2013 ; 118 : 54-58.
- Pascal-Mousselard H, Smadja D, Cabre P, Raynaud M, Catonne Y. Ossification of the ligamenta flava with severe myelopathy in a black patient: a case report. Spine 1998, 23 :1607-1608.
- Wiseman D B, Stokes JK, Toselli R M. Paraparesis in a black man brought on by ossification of the ligamentum flavum: case report and review of the literature. Clinical Spine Surgery 2002, 15 : 542-545.
- Guo JJ, Luk KD, Karppinen J, Yang H, Cheung KM. Prevalence, distribution, and Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study ofone thousand seven hundred thirty-six magnetic resonance imaging scans. spine (Phila Pa 1976). 2010; 35:51-6. doi: 10.1097/BRS.0b013e3181b3f779.
- Yoon SH, Kim WH, Chung S-B, Jin YJ, Park KW, Lee JW, Chung S-K, Kim K-J, Yeom JS, Jahng T-A, Chung CK, Kang HS, Kim H-J. Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion. Eur Spine J 2011 ; 20 : 216-223.
- Onishi E, Yasuda T, Yamamoto H, Iwaki K, Ota S. Outcomes of Surgical Treatment for Thoracic Myelopathy: A Single-institutional Study of 73 Patients. Spine 2016 ; 41(22), E1356-E1363.
- Arafat QW, Jackowski A, Chavda SV, West RJ. Case report: ossification of the thoracic ligamenta flava in a Caucasian: a rare cause of myelopathy. Br J Radiol. 1993;66:1193–1196. [PubMed]
- Tokala DP, Lam KS, Prince HG. Ossification of the proximal thoracic ligamenta flava causing acute myelopathy in a Caucasian: case report and literature review. Spinal Cord. 2007;45:310–313.
- Li H, Jiang LS, Dai LY. Hormones and growth factors in the pathogenesis of spinal ligament ossification. Eur Spine J. 2007;16:1075–1084. [PMC free article] [PubMed]
- Hanakita J, Suwa H, Ohta F, Nishi S, Sakaida H, Iihara K. Neuroradiological examination of thoracic radiculomyelopathy due to ossification of the ligamentum flavum. Neuroradiology 1990;32:38–42. [PubMed]
- Maigne JY, Ayral X, Guerin-Surville H. Frequency and size of ossifications in the caudal attachments of the ligamentum flavum of the thoracic spine. Role of rotatory strains in their development: an anatomic study of 121 spines. Surg Radiol Anat 1992;14:119–124. [PubMed]
- Fukuyama S, Nakamura T, Ikeda T, Takagi K. The effect of mechanical stress on hypertrophy of the lumbar ligamentum flavum. J Spinal Disord. 1995; 8:126–130. [PubMed]
- Yayama T, Uchida K, Kobayashi S, Kokubo Y, Sato R, Nakajima H, Takamura T, Bangirana A, Itoh H, Baba H. Thoracic ossification of the human ligamentum flavum: histopathological and immunohistochemical findings around the ossified lesion. Journal of neurosurgery 2007; 7 :184-193.
- Wang W, Kong L. Ossification of ligamentum. Journal of neurosurgery. Spine 2007 ; 6 : 96-author.
- Giulioni M, Zucchelli M, Damiani S. Thoracic myelopathy caused by calcified ligamentum flavum. Joint Bone Spine. 2007;74:504–505. [PubMed]
- Polgar F. Uber interakuelle wirbelverkalkung. Fortschr Geb Rongenstr Nuklearmed Erganzungsband.1920;40:292–8.
- Sato T, Tanaka Y, Aizawa T, Koizumi Y, Kokubun S. Surgical treatment for ossification of ligamentum flavum in the thoracic spine and its complications. Spine Spinal Cord 1998;11:505–510.
- Sugimura H, Kakitsubata Y, Suzuki Y, et al. MRI of ossification of ligamentum flavum. J Comput Assist Tomogr 1992;16:73–76. [PubMed]
- Trivedi P, Behari S, Paul L, Banerji D, Jain VK, Chhabra DK. Thoracic myelopathy secondary to ossified ligamentum flavum. Acta Neurochir (Wien) 2001;143:775–782. [PubMed]
- Wang L-F, Zhang Y-Z, Shen Y, Su Y-L, Xu J-X, Ding W-Y, Zhang Y-H. Using the T2-weighted magnetic resonance imaging signal intensity ratio and clinical manifestations to assess the prognosis of patients with cervical ossification of the posterior longitudinal ligament. J Neurosurg Spine 2010 ; 13: 319–23 [PubMed]
- Smith DE, Godersky JC. Thoracic spondylosis: an unusual cause of myelopathy. Neurosurgery 1987; 20:589–593. [PubMed]
- Cabre P, Pascal-Moussellard H, Kaidomar S. Bucki B, Bardin T, Smadja D, Arfi S. Six cases of cervical ligamentum flavum calcification in Blacks in the French West Indies. Joint Bone Spine 2001 ; 68 : 158-165.
- Li F, Chen Q, Xu K. Surgical treatment of 40 patients with thoracic ossification of the ligamentum flavum. Journal of Neurosurgery : Spine 2006 ; 4 : 191-197.
- Zhang J, Wang L, Li J, Yang P, Shen Y. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity. Scientific reports 2016 ; 6.
- Park BC, Min WK, Oh CW, Jeon I H, Kim SY, Kyung HS, Oh SH. Surgical outcome of thoracic myelopathy secondary to ossification of ligamentum flavum. Joint Bone Spine 2007 ; 74 : 600-605.
References
Akhaddar A, Mansour A, Zrara I, Gazzaz M, Maftah M, Mostarchid B, Benomar S, Boucetta M. Compression médullaire thoracique secondaire à une ossification des ligaments jaunes. Rev Rhum 2002 ; 69 :548-52.
Nishiura I, Isozuni T, Nishihara K, Handa H, Koyoma T. Surgical approach to ossification of the thoracic yellow ligament. Surg Neurol 1999 ; 283-372.
Hamouda KB, Jemel H, Haouet S, Khaldi M. Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases. Journal of Neurosurgery: Spine 2003; 99: 157-161.
Ahn DK, Lee S, Moon SH, Boo KH, Chang BK, Lee JI. Ossification of the ligamentum flavum. Asian spine journal 2014 ; 8 : 89-96.
Yabe Y, Honda M, Hagiwara Y, Tohjo Y, Nakajima S, Ando A, Sonofuchi K, Itoi E. Thoracic radiculopathy caused by ossification of the ligamentum flavum. Upsala journal of medical sciences 2013 ; 118 : 54-58.
Pascal-Mousselard H, Smadja D, Cabre P, Raynaud M, Catonne Y. Ossification of the ligamenta flava with severe myelopathy in a black patient: a case report. Spine 1998, 23 :1607-1608.
Wiseman D B, Stokes JK, Toselli R M. Paraparesis in a black man brought on by ossification of the ligamentum flavum: case report and review of the literature. Clinical Spine Surgery 2002, 15 : 542-545.
Guo JJ, Luk KD, Karppinen J, Yang H, Cheung KM. Prevalence, distribution, and Prevalence, distribution, and morphology of ossification of the ligamentum flavum: a population study ofone thousand seven hundred thirty-six magnetic resonance imaging scans. spine (Phila Pa 1976). 2010; 35:51-6. doi: 10.1097/BRS.0b013e3181b3f779.
Yoon SH, Kim WH, Chung S-B, Jin YJ, Park KW, Lee JW, Chung S-K, Kim K-J, Yeom JS, Jahng T-A, Chung CK, Kang HS, Kim H-J. Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion. Eur Spine J 2011 ; 20 : 216-223.
Onishi E, Yasuda T, Yamamoto H, Iwaki K, Ota S. Outcomes of Surgical Treatment for Thoracic Myelopathy: A Single-institutional Study of 73 Patients. Spine 2016 ; 41(22), E1356-E1363.
Arafat QW, Jackowski A, Chavda SV, West RJ. Case report: ossification of the thoracic ligamenta flava in a Caucasian: a rare cause of myelopathy. Br J Radiol. 1993;66:1193–1196. [PubMed]
Tokala DP, Lam KS, Prince HG. Ossification of the proximal thoracic ligamenta flava causing acute myelopathy in a Caucasian: case report and literature review. Spinal Cord. 2007;45:310–313.
Li H, Jiang LS, Dai LY. Hormones and growth factors in the pathogenesis of spinal ligament ossification. Eur Spine J. 2007;16:1075–1084. [PMC free article] [PubMed]
Hanakita J, Suwa H, Ohta F, Nishi S, Sakaida H, Iihara K. Neuroradiological examination of thoracic radiculomyelopathy due to ossification of the ligamentum flavum. Neuroradiology 1990;32:38–42. [PubMed]
Maigne JY, Ayral X, Guerin-Surville H. Frequency and size of ossifications in the caudal attachments of the ligamentum flavum of the thoracic spine. Role of rotatory strains in their development: an anatomic study of 121 spines. Surg Radiol Anat 1992;14:119–124. [PubMed]
Fukuyama S, Nakamura T, Ikeda T, Takagi K. The effect of mechanical stress on hypertrophy of the lumbar ligamentum flavum. J Spinal Disord. 1995; 8:126–130. [PubMed]
Yayama T, Uchida K, Kobayashi S, Kokubo Y, Sato R, Nakajima H, Takamura T, Bangirana A, Itoh H, Baba H. Thoracic ossification of the human ligamentum flavum: histopathological and immunohistochemical findings around the ossified lesion. Journal of neurosurgery 2007; 7 :184-193.
Wang W, Kong L. Ossification of ligamentum. Journal of neurosurgery. Spine 2007 ; 6 : 96-author.
Giulioni M, Zucchelli M, Damiani S. Thoracic myelopathy caused by calcified ligamentum flavum. Joint Bone Spine. 2007;74:504–505. [PubMed]
Polgar F. Uber interakuelle wirbelverkalkung. Fortschr Geb Rongenstr Nuklearmed Erganzungsband.1920;40:292–8.
Sato T, Tanaka Y, Aizawa T, Koizumi Y, Kokubun S. Surgical treatment for ossification of ligamentum flavum in the thoracic spine and its complications. Spine Spinal Cord 1998;11:505–510.
Sugimura H, Kakitsubata Y, Suzuki Y, et al. MRI of ossification of ligamentum flavum. J Comput Assist Tomogr 1992;16:73–76. [PubMed]
Trivedi P, Behari S, Paul L, Banerji D, Jain VK, Chhabra DK. Thoracic myelopathy secondary to ossified ligamentum flavum. Acta Neurochir (Wien) 2001;143:775–782. [PubMed]
Wang L-F, Zhang Y-Z, Shen Y, Su Y-L, Xu J-X, Ding W-Y, Zhang Y-H. Using the T2-weighted magnetic resonance imaging signal intensity ratio and clinical manifestations to assess the prognosis of patients with cervical ossification of the posterior longitudinal ligament. J Neurosurg Spine 2010 ; 13: 319–23 [PubMed]
Smith DE, Godersky JC. Thoracic spondylosis: an unusual cause of myelopathy. Neurosurgery 1987; 20:589–593. [PubMed]
Cabre P, Pascal-Moussellard H, Kaidomar S. Bucki B, Bardin T, Smadja D, Arfi S. Six cases of cervical ligamentum flavum calcification in Blacks in the French West Indies. Joint Bone Spine 2001 ; 68 : 158-165.
Li F, Chen Q, Xu K. Surgical treatment of 40 patients with thoracic ossification of the ligamentum flavum. Journal of Neurosurgery : Spine 2006 ; 4 : 191-197.
Zhang J, Wang L, Li J, Yang P, Shen Y. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity. Scientific reports 2016 ; 6.
Park BC, Min WK, Oh CW, Jeon I H, Kim SY, Kyung HS, Oh SH. Surgical outcome of thoracic myelopathy secondary to ossification of ligamentum flavum. Joint Bone Spine 2007 ; 74 : 600-605.