The spine journal : official journal of the North American Spine Society
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Ossification of the ligamentum flavum (OLF) may result in thoracic myelopathy (TM) because of narrowing of the spinal canal. Because symptoms vary and are subjective, diagnosis of TM caused by OLF is sometimes difficult when based on symptoms and physical examination. Posterior decompression is indicated in patients with TM caused by OLF because it is believed that surgery is the most effective treatment. However, surgical outcomes vary. We are unaware of reports of objective presurgical diagnostic parameters, such as neurologic and radiologic findings, relating to the postsurgical prognosis in patients with TM caused by OLF. ⋯ An excellent postoperative prognosis is not always possible in patients with TM caused by OLF. It may be important to check for impairment of joint position sense in the big toe, the number of levels affected by OLF, and presurgical intramedullary signal change on MRI before continuing to surgery.
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Cervical spondylotic myelopathy (CSM) is a common disorder, but its management and the role of surgery are still a matter of controversy. The assessment of surgical outcome is complicated by the lack of reliable and objective methods to assess the severity of the myelopathy and its evolution. Motor-evoked potentials (MEPs) are a useful and reliable tool to measure noninvasively the involvement of the corticospinal tract in patients with CSM. Recent evidence suggests that MEPs could also have a role in monitoring the effect of surgical therapy. ⋯ Early surgical intervention for CSM could produce a beneficial effect on spinal cord functionality that can be detected by MEPs.
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Thoracic myelopathy caused by multilevel (three or more levels) ossification of the ligamentum flavum (OLF) is rare. Little is known about its clinical features, and the surgical outcomes along with its related factors are also unclear. ⋯ Laminectomy with partially internal fixation is safe and effective in treatment of patients with symptomatic multilevel OLF. The results of our study show that preoperative JOA score and preoperative duration of symptoms were important predictors for the clinical outcome.
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No study has determined time trends of neck pain and low back pain (NP&LBP) in the 20th century in Spain. ⋯ The prevalence of NP and NP&LBP, but not LBP, has decreased in the last years in Spain. NP&LBP were associated with similar sociodemographic and lifestyle habits in 2009 compared with 2006.