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Medicine (Baltimore) 2022 Apr 22;101(16):e29188. Epub 2022 Apr 22.

Princess Alexandra Hospital, Woolloongabba Queensland, Australia.

Rationale: Surfer's myelopathy is a rare atraumatic spinal cord injury most frequently experienced by novice surfers. Patients often experience back pain, followed by motor, sensory, bowel, and bladder involvement. Here, we report a case of surfer's myelopathy. Read More

J Clin Endocrinol Metab 2022 Apr 22. Epub 2022 Apr 22.

Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, 513 Parnassus Ave., HSE901, San Francisco, CA.

Purpose: Heterotopic ossification (HO) is a process by which bone forms abnormally in soft tissues. Known risk factors for developing HO include male sex, spinal cord injury, trauma, and surgery. We investigated additional risk factors in the development of HO after hip arthroplasty. Read More

J Orthop Case Rep 2021 Jun;11(6):97-101

Department of Orthopaedic, Andrea Hospital, University of Rome "Sapienza," Italy. Via di Grottarossa 1035, Rome, Italy.

Introduction: Up to 30% of patients with spinal cord injury and to 20% of patients with traumatic brain injury develop neurogenic heterotopic ossification (NHO). Patients develop restriction in joint range of motion (ROM) and impairment in activities of daily life. When neurological recovery occurs, joints dysfunction represents the cause for patients' autonomy loss. Read More

Neurotrauma Rep 2022 22;3(1):87-96. Epub 2022 Feb 22.

Mater Research Institute, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia.

Neurogenic heterotopic ossifications (NHOs) are incapacitating complications of traumatic brain and spinal cord injuries (SCI) that manifest as abnormal bone formation in periarticular muscles. Using a unique model of NHO after SCI in genetically unmodified mice, we have previously established that the innate immune system plays a key driving role in NHO pathogenesis. The role of adaptive immune cells in NHO pathogenesis, however, remains unexplored in this model. Read More

J Clin Neurosci 2022 May 4;99:53-61. Epub 2022 Mar 4.

Department of Neurosurgery, University of Cambridge, Cambridge, UK. Electronic address:

Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine. It is typically diagnosed on clinical symptoms and examination findings together with MRI findings. In this study, we explore the significance of these degenerative pathology to onset of DCM by performing the first meta-analysis on the prevalence of degenerative features reported on MRI amongst healthy and asymptomatic populations and compare this to the prevalence of degenerative features reported on MRI amongst a symptomatic population calculated in a previous review. Read More

Biomed Res Int 2022 17;2022:1572341. Epub 2022 Feb 17.

Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China.

Purpose: To investigate the factors associated with the prognosis of spinal cord injury without radiographic abnormality (SCIWORA) accompanied by cervical ossification of the posterior longitudinal ligament (C-OPLL).

Methods: We retrospectively investigated 287 patients with SCIWORA associated with C-OPLL, who were admitted within 30 days after trauma to our facility between August 2014 and August 2018. All patients were divided into the good or poor prognosis group. Read More

Front Cell Neurosci 2022 9;16:842090. Epub 2022 Feb 9.

Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.

: In spinal cord injury (SCI), heterotopic ossification is a frequent secondary complication, commonly associated with limited range of motion of affected joints, which could lead to secondary disability in activities of daily living. Additionally, heterotopic ossifications might challenge the effect of regeneration-promoting therapies on neurological and functional recovery. This study evaluated the impact of heterotopic ossification on clinical recovery within the first year after SCI. Read More

Spine J 2022 Jun 10;22(6):934-940. Epub 2022 Jan 10.

Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.

Background Context: Its rare prevalence and subtle radiological changes often lead to difficulties in diagnosing cervical ossification of the posterior longitudinal ligament (OPLL) on plain radiographs. However, OPLL progression may lead to trauma-induced spinal cord injury, resulting in severe paralysis. To address the difficulties in diagnosis, a deep learning approach using a convolutional neural network (CNN) was applied. Read More

J Spinal Cord Med 2021 Dec 22:1-14. Epub 2021 Dec 22.

KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.

Background: Serum alkaline phosphatase (ALP) is measured as an indicator of bone or liver disease. Bone-specific alkaline phosphatase (B-ALP) is an isoform of ALP found in the bone tissue which can predict fractures and heterotopic ossification.

Objective: The aim of this scoping review was to explore the current use of ALP and B-ALP in studies using humans or animal models of SCI, and to identify ways to advance future research using ALP and B-ALP as a bone marker after SCI. Read More

Bone 2022 02 8;155:116287. Epub 2021 Dec 8.

Bone Biology Laboratory, School of Medicine, Rosario National University, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina. Electronic address:

Heterotopic ossification (HO) is the formation of extraskeletal bone in muscle and soft tissues and could be genetic or non-genetic. The classic presentation of non-genetic HO is in young adults with a clear history of local trauma, surgery or prolonged immobilization after spinal cord and traumatic brain injuries. Genetic HO has a significant clinical severity compared to non-genetic causes and includes fibrodysplasia ossificans progressiva (FOP). Read More

J Bone Miner Res 2022 03 13;37(3):531-546. Epub 2021 Dec 13.

Mater Research Institute - The University of Queensland, Woolloongabba, Australia.

Neurogenic heterotopic ossifications (NHOs) form in periarticular muscles after severe spinal cord (SCI) and traumatic brain injuries. The pathogenesis of NHO is poorly understood with no effective preventive treatment. The only curative treatment remains surgical resection of pathological NHOs. Read More

World Neurosurg 2021 12 17;156:e249-e253. Epub 2021 Sep 17.

Department of Spine, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, Fujian, China; Department of Spine, Fujian Provinical Clinical MedIcal Research Center for First Aid and Rehabiliation in Orthopaedic Trauma (2021), Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, Fujian, China.

Background: Thoracic ossification of the ligamentum flavum (OLF) is a pathologic condition that affects ligamentation of the OLF and causes slowly progressive myeloradiculopathy. There is a trend toward performing minimally invasive surgery. In this study, we assess the long-term efficacy of percutaneous endoscopic surgical management of thoracic OLF. Read More

Spine (Phila Pa 1976) 2021 Sep;46(17):1197-1205

Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.

Study Design: A retrospective cohort analysis.

Objective: The aim of this study was to investigate the impact of piecemeal versus en bloc laminectomies on spinal cord in thoracic ossification of ligamentum flavum (TOLF) through intraoperative changes of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs).

Summary Of Background Data: Surgical treatment is indicated for symptomatic TOLF, and both piecemeal and en bloc laminectomies are commonly used methods. Read More

Spinal Cord Ser Cases 2021 07 31;7(1):69. Epub 2021 Jul 31.

Department of Spine Surgery, Indian Spinal Injuries Center, New Delhi, India.

Introduction: Achondroplasia is a rare autosomal dominant condition characterized by stenosis in spinal canal. Multilevel Ossification of the ligamentum flavum in the spine is a rare occurrence which too can contribute to stenosed canal.

Case Presentation: We report a case of an Indian achondroplasic dwarf with multilevel ossification of ligamentum flavum (OLF) at thoracic and lumbar segment. Read More

J Neurosurg Spine 2021 Jul 23;35(4):410-418. Epub 2021 Jul 23.

3Department of Orthopedics, Yokohama City University School of Medicine, Yokohama City, Japan.

Objective: Although anterior compression factors and cervical alignment affect neural decompression, cervical laminoplasty may be used to achieve indirect posterior decompression. The focal apex (FA) angle of the anterior compression factor of the spine represents the degree of anterior prominence toward the spinal cord. The authors investigated the mechanism underlying the influence of FA angle and cervical alignment on spinal cord alignment (SCA) after laminoplasty, including how high-intensity signal cord change (HISCC) on preoperative T2-weighted MRI (T2-MRI) may affect neurological improvement. Read More

BMJ Case Rep 2021 Jul 12;14(7). Epub 2021 Jul 12.

Department of Surgery, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia

Postoperative pseudomeningocele usually has a benign course. We report a rare presentation of postoperative acute neurological deficit caused by compressive thoracic pseudomeningocele. This patient had posterior spinal fusion and decompression surgery for thoracic ossification of posterior longitudinal ligament and ligamentum flavum. Read More

Spinal Cord Ser Cases 2021 07 9;7(1):57. Epub 2021 Jul 9.

Spine Team, Orthopaedics and Traumatology, Centro Médico Integral Fitz Roy, Buenos Aires, Argentina.

Introduction: Acute spinal cord injury without tomographic evidence of vertebral fracture or dislocation in patients post trauma can represent a diagnostic challenge for the treating physician. The ossification of thoracic ligamentum flavum has been widely published as a cause of thoracic myelopathy, however its association with acute traumatic spinal cord injury is limited to isolated cases.

Case Presentation: we report a Caucasian 37-year-old man who suffered a high-energy thoracolumbar spine trauma in a motorcycle accident with acute paraplegia. Read More

J Orthop Case Rep 2021 Mar;11(3):45-51

Department of Orthopaedic Surgery, Jordan University Hospitals, Amman, Jordan.

Introduction: Myositis ossificans (MO) is a benign non-neoplastic condition in which heterotopic bone formation occurs in soft tissues. Neurogenic MO is one variant of MO where the lesion is a result of neurological disorders, including brain and spinal cord injuries, especially when followed by immobility and spasticity. MO can also be a result of direct trauma or even genetic mutations. Read More

Spine (Phila Pa 1976) 2022 Jan;47(1):E27-E37

The Monitoring Committee of the Japanese Society for Spine Surgery and Related Research, Japan.

Study Design: A prospective multicenter observational study.

Objective: To elucidate the efficacy of transcranial motor-evoked potentials (Tc(E)-MEPs) in degenerative cervical myelopathy (DCM) surgery by comparing cervical spondylotic myelopathy (CSM) to cervical ossification of the posterior longitudinal ligament (OPLL) and investigate the timing of Tc(E)-MEPs alerts and types of interventions affecting surgical outcomes.

Summary Of Background Data: Although CSM and OPLL are the most commonly encountered diseases of DCM, the benefits of Tc(E)-MEPs for DCM remain unclear and comparisons of these two diseases have not yet been conducted. Read More

Eur Spine J 2021 08 1;30(8):2185-2190. Epub 2021 Jul 1.

Tokyo Medical University, Tokyo, Japan.

Ossification of the posterior longitudinal ligament (OPLL) causes serious problems, such as myelopathy and acute spinal cord injury. The early and accurate diagnosis of OPLL would hence prevent the miserable prognoses. Plain lateral radiography is an essential method for the evaluation of OPLL. Read More

Sci Rep 2021 06 16;11(1):12702. Epub 2021 Jun 16.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Cervical ossification of the posterior longitudinal ligament (OPLL) is a contributing factor to spinal cord injury or trauma-induced myelopathy in the elderly. To reduce the incidence of these traumas, it is essential to diagnose OPLL at an early stage and to educate patients how to prevent falls. We thus evaluated the ability of our convolutional neural network (CNN) to differentially diagnose cervical spondylosis and cervical OPLL. Read More

Oper Neurosurg (Hagerstown) 2021 08;21(3):118-125

Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou, China.

Background: Up to date, surgical outcome of multilevel thoracic ossification of posterior longitudinal ligament (T-OPLL) with high canal occupation ratio is less satisfactory.

Objective: To explore the result of thoracic column antedisplacement and fusion (TCAF) in treatment of multilevel T-OPLL with high canal occupation ratio.

Methods: A total of 5 patients who underwent TCAF procedure for T-OPLL were retrospectively reviewed. Read More

Clin Interv Aging 2021 24;16:897-908. Epub 2021 May 24.

Peking University Third Hospital, Department of Orthopaedics, Beijing, 100191, People's Republic of China.

Purpose: Cervical ossification of ligamentum flavum (COLF) is a rare clinical entity which can occasionally contribute to severe myeloradiculopathy. Many orthopedists are unfamiliar with or underestimate this pathology. Therefore, a comprehensive research is obligatory to reappraise the epidemiological, radiological, clinical and histopathological characteristics of COLF-myeloradiculopathy based on synthesis of individual patient data. Read More

Cureus 2021 Apr 27;13(4):e14709. Epub 2021 Apr 27.

3rd Department of Neurology, National and Kapodistrian University of Athens, Aiginition Hospital, Athens, GRC.

The term neurogenic heterotopic ossification (NHO) is used to describe the pathological bone formation in soft tissues, due to spinal cord or brain injury. Commonly is presented with pain and stiffness of the affected joint. NHO affects the quality of life of these patients, delays their rehabilitation and therefore increases morbidity. Read More

Pain Physician 2021 05;24(3):275-281

Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.

Background: Resection of the ossification of the thoracic ligamentum flavum (OTLF) with a high-speed burr may cause a high rate of perioperative complications, such as dural laceration and/or iatrogenic spinal cord injury.

Objectives: The aim of this study was to investigate the safety and feasibility of the endoscopic-matched ultrasonic osteotome in full-endoscopic spinal surgery for direct removal of OTLF.

Study Design: Retrospective study. Read More

Arthrosc Tech 2021 Apr 22;10(4):e1179-e1186. Epub 2021 Apr 22.

Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.

Heterotopic ossification (HO) can occur as a complication of various pathologies affecting the hip including trauma, tendon avulsions, chronic injury, spinal cord injury, and soft-tissue disruption caused by surgery. When HO is present alongside intra-articular hip pathology such as femoroacetabular impingement syndrome (FAIS) or labral pathology, consideration should be made to combine the surgical excision of the HO with the FAIS decompression or labral repair if the location and size of the HO is appropriate for arthroscopic excision. Often times, the HO is located in such a position that any central compartment work can be completed before turning to the HO excision. Read More

Int J Environ Res Public Health 2021 04 16;18(8). Epub 2021 Apr 16.

Department of Rehabilitation, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland.

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. Read More

J Neurotrauma 2021 08 18;38(15):2162-2175. Epub 2021 Jun 18.

Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia.

Neuroimmune dysfunction is thought to promote the development of several acute and chronic complications in spinal cord injury (SCI) patients. Putative roles for adrenal stress hormones and catecholamines are increasingly being recognized, yet how these adversely affect peripheral tissue homeostasis and repair under SCI conditions remains elusive. Here, we investigated their influence in a mouse model of SCI with acquired neurogenic heterotopic ossification. Read More

J Orthop Surg Res 2021 Apr 26;16(1):277. Epub 2021 Apr 26.

Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, People's Republic of China.

Objective: To explore the clinical efficacy of posterior LFF for cervical OPLL with radicular pain of upper limbs METHODS: Between January 2014 and January 2018, 48 OPLL patients with radicular pain symptoms of upper limbs who underwent a one-stage posterior laminectomy and instrumented fusion with/without foraminotomy were reviewed retrospectively and divided into two groups: LF group (laminectomy with instrumented fusion without foraminotomy) and LFF group (laminectomy with instrumented fusion and foraminotomy). Clinical data were assessed and compared between the two groups. The radicular pain of upper limbs and neck was measured using the visual analog scale (VAS). Read More

Pain Physician 2021 03;24(2):E239-E248

Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.

Background: Conventional open laminectomy is considered to be the standard procedure for the treatment of thoracic ossified ligamentum flavum, but multi-segment thoracic laminectomy extensively removes the facet joints and ligamentous tissue, destroying the thoracic spine biomechanics and stability, may lead to delayed thoracic spine kyphosis deformities, which in turn can lead to potential neurological deterioration and local intractable pain.

Objective: To introduce the technical notes and clinical outcome of ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum.

Study Design: A prospective cohort study. Read More