RESUMEN
CASE: A 30-year-old man with a history of advanced HIV disease (AHD) presented with bilateral equinocavus, leg, and foot muscle paresis, Brooker grade 4 heterotopic ossification of hips and knee stiffness, and was unable to sit upright, stand independently, or walk. Electromyography showed demyelinating sensorimotor and axonal polyneuropathy of lower extremities. Multiple surgeries of bilateral hips, ankles, and feet enabled joint mobility, plantigrade feet, and independent ambulation. CONCLUSION: Patients with AHD may develop multijoint pathologies, secondary to HIV, antiretroviral therapy, or prolonged immobility, resulting in loss of ambulation and independence. Restoring ambulation may necessitate multiple surgeries, with potential for success.
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Infecciones por VIH , Humanos , Masculino , Adulto , Infecciones por VIH/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/cirugía , Osificación Heterotópica/etiologíaRESUMEN
Heterotopic ossification (HO), characterized by the formation of ectopic bone, is a benign mass observed in soft tissues. Depending on its location, it can cause symptoms beyond compression, such as mechanical blockage when associated with joints, leading to limitations in joint movements. In the majority of cases, involvement of the hip and elbow joints is common, while HO can sometimes be observed in atypical locations. Trauma, head injury, and spinal cord injuries are well-recognized risk factors for HO development. However, on rare occasions, in non-traumatic cases are identified without any known risk factors. Herein, we present a rare non-traumatic HO case associated with the flexor hallucis longus (FHL) tendon in a 58-year-old female patient. She complained of pain under the first toe of her right foot while wearing shoes for a year, and a mass was detected on the plantar surface of the foot along with limitation of movement in the first metatarsophalangeal joint. Further examinations revealed that the identified mass was a mature HO lesion. Surgical treatment was performed, and during one-year follow-up, the pain subsided, and joint movements returned to normal, resulting in a satisfactory outcome. In conclusion, although many cases of HO are associated with traumatic injuries, it can sometimes be idiopathic, as in our case, and rarely it is accompanied tendon such as FHL in the foot.
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Osificación Heterotópica , Humanos , Osificación Heterotópica/cirugía , Osificación Heterotópica/patología , Osificación Heterotópica/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/diagnóstico , Femenino , Persona de Mediana Edad , Tendones/patología , Resultado del Tratamiento , Articulación Metatarsofalángica/patología , Articulación Metatarsofalángica/lesiones , Articulación Metatarsofalángica/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
CASE: A 27-year-old man sustained chemical burns affecting 54% of his body caused by steam and acetic acid at a dyeing factory. He developed restricted bilateral elbow and shoulder motion because of heterotopic ossification (HO) beginning 3 months after the incident. The skin healed within 1 year, but ankylosis developed because of progressing ossification. We performed HO surgical excision in 4 stages. Two years after the final surgery, the function of both upper extremities had recovered. CONCLUSION: For HO caused by severe burns, improvement in upper extremity function can be achieved even if surgery is performed after skin healing.
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Articulación del Codo , Osificación Heterotópica , Articulación del Hombro , Humanos , Osificación Heterotópica/cirugía , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/etiología , Masculino , Adulto , Articulación del Hombro/cirugía , Articulación del Hombro/diagnóstico por imagen , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Quemaduras Químicas/cirugía , Quemaduras Químicas/complicacionesRESUMEN
Background: The morphology of the suprascapular notch (SSN) and the ossification of the superior transverse suprascapular ligament (STSL) are risk factors for injury of the suprascapular nerve (SN) during arthroscopic shoulder procedures. The purpose of the current study was to compare preoperative clinical and radiologic characteristics between patients with and without STSL ossification and to evaluate SSN morphology in patients who underwent arthroscopic rotator cuff repair using a 3-dimensional (3D) reconstructed model. Methods: Patients who underwent arthroscopic rotator cuff repair and were given a computed tomography (CT) scan from March 2018 to August 2019 were included in this study. Patients were divided into 2 groups: those without STSL ossification (group I) and those with STSL ossification (group II). Tear size of the rotator cuff and fatty infiltration of rotator cuff muscles were assessed in preoperative magnetic resonance imaging. The morphology of the SSN was classified following Rengachary's classification. The transverse and vertical diameters of the SSN and the distances from anatomical landmarks to the STSL were measured. All measurements were completed using a 3D CT reconstructed scapula model. Results: A total of 200 patients were included in this study. One hundred seventy-eight patients (89.0%) without STSL ossification were included in group I, and 22 patients (11.0%) with STSL ossification were included in group II. Group II showed a significantly advanced age (61.0 ± 7.4 vs. 71.0 ± 7.3 years, p < 0.001) and a shorter transverse diameter of SSN (10.7 ± 3.1 mm vs. 6.1 ± 3.7 mm, p < 0.001) than group I. In the logistic regression analysis, age was an independent prognostic factor for STSL ossification (odds ratio, 1.201; 95% confidence interval, 1.112-1.296; p < 0.001). Patients in type VI showed significantly shorter transverse diameters than other types (p < 0.001). The patient with type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than those with other types (p < 0.001). Conclusions: In the 3D morphological analysis, age was the independent factor associated with STSL ossification in patients who underwent arthroscopic rotator cuff repair. Type VI showed significantly shorter transverse diameters than other types. Type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than other types.
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Artroscopía , Imagenología Tridimensional , Lesiones del Manguito de los Rotadores , Tomografía Computarizada por Rayos X , Humanos , Artroscopía/métodos , Femenino , Masculino , Persona de Mediana Edad , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Anciano , Estudios Retrospectivos , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/cirugía , Manguito de los Rotadores/cirugía , Manguito de los Rotadores/diagnóstico por imagen , Escápula/diagnóstico por imagen , Escápula/cirugía , Ligamentos Articulares/cirugía , Ligamentos Articulares/diagnóstico por imagen , AdultoRESUMEN
Heterotopic ossification (HO) is characterized by the formation of pathological bone within the soft tissues. HO predominantly affects elbow joints and may be accompanied by tardy ulnar nerve palsy. This study aimed to explore the clinical and functional outcomes of patients with tardy ulnar nerve palsy caused by HO following surgical treatment, with a review of the relevant literature. A retrospective study was conducted on 4 patients with tardy ulnar nerve palsy caused by HO, who underwent anterior subcutaneous ulnar nerve transposition between 2015 and 2020. The patients were followed up for more than 1 year and the cause of HO was also identified. Clinical and functional outcomes were evaluating using the grip strength and pinch strength, visual analog scale (VAS) pain score and Quick disabilities of the arm, shoulder and hand (DASH) score. The causes of HO were repetitive micro-trauma in 1 case and excessive physical or rehabilitation therapy in 3 cases. The average follow-up period was 15.6 months (range; 12-21 months). The grip strength increased from an average of 14kg to 26.5kg. The pinch strength increased from an average of 1.5 kg to 3.63 kg. The Quick DASH score decreased from an average of 55.6 to 6.15. The VAS score for pain decreased from an average of 7 to 0.25. Rapid surgical treatment, including removal of the heterotopic bone and ulnar nerve anterior transposition, might improve outcomes in patients with tardy ulnar nerve palsy caused by HO.
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Osificación Heterotópica , Humanos , Osificación Heterotópica/cirugía , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Adulto , Neuropatías Cubitales/cirugía , Neuropatías Cubitales/etiología , Fuerza de la Mano , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Nervio Cubital/cirugía , Resultado del Tratamiento , Dimensión del Dolor , AncianoRESUMEN
PURPOSE: We aim to analyse and compare the efficacy of the excision of HO around the hip with and without CT-guided navigation. We also aim to compare the functional outcome between CT navigation guided versus conventional excision of HO. PATIENTS AND METHODS: This study is a retrospective analysis of prospectively collected data from 2015 to 2022. There were 23 patients (24 hips) in the final cohort. Intraoperative CT navigation guided excision was performed in 7 hips and conventional excision of HO was done in 17 hips. The HO was classified by Brooker's grading in radiographs. CT scan was taken preoperatively in all patients to exactly identify the volume, location and preoperative planning. The functional outcome was analysed according to Harris Hip Score (HHS) and International Hip Outcome Tool (iHOT) for self-ambulatory patients and improvement in the sitting or nursing care was assessed in patients mobilising with wheelchair or walker support. Any complications or recurrence noted postoperatively and in follow-up were recorded. RESULTS: The mean follow-up was 41.2 months in the CT navigation-guided excision group and 55 months in the conventional excision group. According to Brooker's grading, grade IV was present in 20 hips and grade III in four hips. Twelve patients were self-ambulatory and the other 12 patients were requiring support for mobilisation. There was a significant improvement in the HHS from 21.3 ± 3.7, 18.3 ± 2.5 preoperatively to 75.2 ± 8.3, 72.2 ± 4.3 postoperatively in the CT navigation guided and conventional group respectively (p < 0.001) in the self-ambulatory group. There was one anterior wall and one partial posterior wall fracture in the conventional group. One patient in the conventional group had a deep infection and recurrence. One patient had a superficial infection and another had superficial vein thrombosis in the CT guided excision group. CONCLUSION: Intraoperative CT navigation helps to exactly localize the HO and facilitates safe excision. Functional excision of the HO leads to better nursing care and functional outcomes between both groups.
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Osificación Heterotópica , Cirugía Asistida por Computador , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Persona de Mediana Edad , Cirugía Asistida por Computador/métodos , Adulto , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/cirugía , Articulación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagen , Resultado del Tratamiento , AncianoRESUMEN
Background: Eagle syndrome is caused by an elongated styloid process affecting carotid arteries and cranial nerves. Pain, dysphagia, tinnitus, paresthesia (classic subtype), and neurovascular events (vascular subtype) may be triggered by head movements or arise spontaneously. However, Eagle syndrome remains underappreciated in the neurological community. We aimed to determine the most common neurological and non-neurological clinical presentations in patients with Eagle syndrome and to assess the clinical outcome post-surgical resection in comparison to non-surgical therapies. Methodology: We conducted a systematic review of patient-level data on adults with Eagle syndrome, following PRISMA guidelines. We extracted data on demographics, presenting symptoms, neurological deficits, radiological findings, and treatments, including outcomes and complications, from studies in multiple indexing databases published between 2000 and 2023. The study protocol is registered with PROSPERO. Results: In total, 285 studies met inclusion criteria, including 497 patients with Eagle syndrome (mean age 47.3 years; 49.8% female). Classical Eagle (370 patients, 74.5%) was more frequent than vascular Eagle syndrome (117 patients, 23.5%, p < 0.0001). Six patients (1.2%) presented with both variants and the subvariant for four patients (0.8%) was unknown. There was a male preponderance (70.1% male) in the vascular subtype. A history of tonsillectomy was more frequent in classic (48/153 cases) than in vascular (2/33 cases) Eagle syndrome (Odds Ratio 5.2, 95% CI [1.2-22.4]; p = 0.028). By contrast, cervical movements as trigger factors were more prevalent in vascular (12/33 cases) than in classic (7/153 cases) Eagle syndrome (Odds Ratio 7.95, 95% CI [2.9-21.7]; p = 0.0001). Headache and Horner syndrome were more frequent in vascular Eagle syndrome and dysphagia and neck pain more prominent in classic Eagle syndrome (all p < 0.01). Surgically treated patients achieved overall better outcomes than medically treated ones: Eighty-one (65.9%) of 123 medically treated patients experienced improvement or complete resolution, while the same applied to 313 (97.8%) of 320 surgical patients (Odds Ratio 1.49, 95% CI [1.1-2.0]; p = 0.016). Conclusions: Eagle syndrome is underdiagnosed with potentially serious neurovascular complications, including ischemic stroke. Surgical treatment achieves better outcomes than conservative management. Although traditionally the domain of otorhinolaryngologist, neurologist should include this syndrome in differential diagnostic considerations because of the varied neurological presentations that are amenable to effective treatment.
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Osificación Heterotópica , Hueso Temporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osificación Heterotópica/cirugía , Osificación Heterotópica/terapia , Osificación Heterotópica/epidemiología , Fenotipo , Hueso Temporal/anomalías , Hueso Temporal/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Although posterior decompression with fusion (PDF) are effective for treating thoracic myelopathy, surgical treatment has a high risk of various complications. There is currently no information available on the perioperative complications in thoracic ossification of the longitudinal ligament (T-OPLL) and thoracic ossification of the ligamentum flavum (T-OLF). We evaluate the perioperative complication rate and cost between T-OPLL and T-OLF for patients underwent PDF. METHODS: Patients undergoing PDF for T-OPLL and T-OLF from 2012 to 2018 were detected in Japanese nationwide inpatient database. One-to-one propensity score matching between T-OPLL and T-OLF was performed based on patient characteristics and preoperative comorbidities. We examined systemic and local complication rate, reoperation rate, length of hospital stays, costs, discharge destination, and mortality after matching. RESULTS: In a total of 2,660 patients, 828 pairs of T-OPLL and T-OLF patients were included after matching. The incidence of systemic complications did not differ significantly between the T-OPLL and OLF groups. However, local complications were more frequently occurred in T-OPLL than in T-OLF groups (11.4% vs. 7.7% P = 0.012). Transfusion rates was also significantly higher in the T-OPLL group (14.1% vs. 9.4%, P = 0.003). T-OPLL group had longer hospital stay (42.2 days vs. 36.2 days, P = 0.004) and higher medical costs (USD 32,805 vs. USD 25,134, P < 0.001). In both T-OPLL and T-OLF, the occurrence of perioperative complications led to longer hospital stay and higher medical costs. While fewer patients in T-OPLL were discharged home (51.6% vs. 65.1%, P < 0.001), patients were transferred to other hospitals more frequently (47.5% vs. 33.5%, P = 0.001). CONCLUSION: This research identified the perioperative complications of T-OPLL and T-OLF in PDF using a large national database, which revealed that the incidence of local complications was higher in the T-OPLL patients. Perioperative complications resulted in longer hospital stays and higher medical costs.
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Bases de Datos Factuales , Descompresión Quirúrgica , Ligamento Amarillo , Osificación del Ligamento Longitudinal Posterior , Complicaciones Posoperatorias , Fusión Vertebral , Vértebras Torácicas , Humanos , Masculino , Femenino , Vértebras Torácicas/cirugía , Ligamento Amarillo/cirugía , Fusión Vertebral/economía , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Persona de Mediana Edad , Descompresión Quirúrgica/economía , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/métodos , Anciano , Osificación del Ligamento Longitudinal Posterior/cirugía , Osificación del Ligamento Longitudinal Posterior/economía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/economía , Japón/epidemiología , Osificación Heterotópica/cirugía , Osificación Heterotópica/economía , Osificación Heterotópica/epidemiología , Tiempo de Internación/economía , Reoperación/economía , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Pacientes Internos , Resultado del TratamientoRESUMEN
In recent years, there has been growing interest in an alternative approach for treating TOLF, such as endoscopic decompression, which minimizes the disruption of surrounding tissues. It is important to understand the advantages, disadvantages, and potential differences in outcomes associated with each approach. This comparative study aims to evaluate and contrast the effectiveness, safety, and outcomes of these two surgical techniques, open laminectomy and endoscopic decompression, in the management of thoracic OLF. The literature review was conducted on Embase, PubMed, Scopus and Google Scholar databases. After a thorough screening of all search results, 14 studies were shortlisted, from which data was extracted, and statistical analysis was done. Pooled analysis was done to ascertain the intra-operative and post-operative outcomes after surgery for TOLF. Overall, 351 patients were included in the study for evaluation. 174 patients were operated on by open laminectomy, and 177 patients were seen in the endoscopy group. Decreased operative time was seen in the endoscopic subgroup. The mean length of hospital stay of 6.6 days. Both groups showed improvement in mJOA and VAS score. The recovery rate for the reported study cohort was 66.8%, with the Endoscopic surgical approach showing a positive correlation with the mean recovery rate. The dural tear was the most common complication, with a rate of 6.6%. The mean estimated infection rate was 2.7% and postoperative CSF leak was 3.7%, with a trend of significantly higher rates in the open subgroup. Both of the groups showed improvement in functional scores, VAS scores, and cross-sectional area. However, the Endoscopic decompression group experienced reduced hospital stays, operating times, and intraoperative blood loss. The most frequent side effects were CSF leak and dural tear. A few cases showed revision and infection. None of the problems differed between the groups.
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Descompresión Quirúrgica , Laminectomía , Ligamento Amarillo , Vértebras Torácicas , Humanos , Descompresión Quirúrgica/métodos , Endoscopía/métodos , Laminectomía/métodos , Ligamento Amarillo/cirugía , Neuroendoscopía/métodos , Osificación Heterotópica/cirugía , Complicaciones Posoperatorias/epidemiología , Vértebras Torácicas/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: Spinal tuberculosis, if not promptly treated, can lead to kyphotic deformity, causing persistent neurological abnormalities and discomfort. Spinal cord compression can occur due to ossification of the ligamentum flavum (OLF) at the apex of kyphosis. Traditional surgical interventions, including osteotomy and fixation, pose challenges and risks. We present a case of thoracic myelopathy in a patient with post-tuberculosis kyphosis, successfully treated with biportal endoscopic spinal surgery (BESS). METHOD: A 73-year-old female with a history of untreated kyphosis presented with walking difficulties and lower limb pain. Imaging revealed a kyphotic deformity of 120° and OLF-induced cord compression at T8-9. UBE was performed under spinal anesthesia. Using the BESS technique, OLF was successfully removed with minimal damage to the stabilizing structures. RESULTS: The patient exhibited neurological improvement after surgery, walking on the first day without gait instability. Follow-up at 1 year showed no kyphosis progression or recurrence of symptoms. BESS successfully resolved the cord compression lesion with minimal blood loss and damage. CONCLUSION: In spinal tuberculosis-related OLF, conventional open surgery poses challenges. BESS emerges as an excellent alternative, providing effective decompression with reduced instrumentation needs, minimal blood loss, and preservation of surrounding structures. Careful patient selection and surgical planning are crucial for optimal outcomes in endoscopic procedures.
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Descompresión Quirúrgica , Endoscopía , Cifosis , Ligamento Amarillo , Osificación Heterotópica , Tuberculosis de la Columna Vertebral , Humanos , Anciano , Femenino , Cifosis/cirugía , Cifosis/etiología , Cifosis/diagnóstico por imagen , Ligamento Amarillo/cirugía , Ligamento Amarillo/diagnóstico por imagen , Descompresión Quirúrgica/métodos , Tuberculosis de la Columna Vertebral/cirugía , Tuberculosis de la Columna Vertebral/complicaciones , Tuberculosis de la Columna Vertebral/diagnóstico por imagen , Endoscopía/métodos , Osificación Heterotópica/cirugía , Osificación Heterotópica/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Vértebras Torácicas/cirugía , Vértebras Torácicas/diagnóstico por imagen , Resultado del TratamientoRESUMEN
CASE: A patient presented with complete coracoclavicular ligament ossification after an unnoticed acromioclavicular joint Rockwood Type IV dislocation. He had full passive range of motion in the glenohumeral joint but was disabled by a loss of both active (80°) and passive (90°) abduction due to insufficient passive scapulo-thoracic motion. He was treated with an arthroscopic osteotomy of the coracoclavicular ligament ossification. CONCLUSION: One year after the surgery, active abduction was improved by 45° (80°-125°) with no recurrence of the ossification on the radiographs. Arthroscopic osteotomy of complete coracoclavicular ligament ossification seems effective in restoring abduction in these patients. LEVEL OF EVIDENCE: IV.
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Articulación Acromioclavicular , Ligamentos Articulares , Osificación Heterotópica , Humanos , Masculino , Articulación Acromioclavicular/cirugía , Articulación Acromioclavicular/diagnóstico por imagen , Osificación Heterotópica/cirugía , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/etiología , Ligamentos Articulares/cirugía , Ligamentos Articulares/diagnóstico por imagen , Artroscopía/métodos , Osteotomía/métodos , AdultoRESUMEN
BACKGROUND: Arterial injury caused by heterotopic ossification (HO) following fractures is rarely reported, yet it can have catastrophic consequences. This case report presents a unique instance of femoral artery injury and hematoma organization, occurring a decade after intramedullary nail fixation for a femoral shaft fracture complicated by HO. CASE PRESENTATION: A 56-year-old male presented with right femoral artery injury and organized hematoma, a decade after suffering bilateral femoral shaft fractures with mild head injury in a traffic accident. He had received intramedullary nailing for the right femoral shaft fracture and plate fixation for the left side in a local hospital. Physical examination revealed two firm, palpable masses with clear boundaries, limited mobility, and no tenderness. Peripheral arterial pulses were intact. Radiography demonstrated satisfactory fracture healing, while a continuous high-density shadow was evident along the inner and posterior aspect of the right thigh. Computed tomography angiography identified a large mixed-density mass (16.8 × 14.8 × 20.7 cm) on the right thigh's medial side, featuring central calcification and multiple internal calcifications. The right deep femoral artery coursed within this mass, with a smaller lesion noted on the posterior thigh. Surgical consultation with a vascular surgeon led to planned intervention. The smaller mass was completely excised, but the larger one partially, as it encased the femoral artery. The inability to remove all HO was due to excessive bleeding. Postoperatively, the patient experienced no complications, and one-year follow-up revealed a favorable recovery with restoration of full right lower limb mobility. CONCLUSION: This case underscores the potential gravity of vascular injury associated with heterotopic ossification. Surgeons should remain vigilant regarding the risk of vascular injury during HO excision.
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Arteria Femoral , Fracturas del Fémur , Osificación Heterotópica , Humanos , Osificación Heterotópica/cirugía , Osificación Heterotópica/etiología , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/complicaciones , Masculino , Arteria Femoral/cirugía , Arteria Femoral/lesiones , Arteria Femoral/diagnóstico por imagen , Persona de Mediana Edad , Fracturas del Fémur/cirugía , Fracturas del Fémur/etiología , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/complicaciones , Fijación Intramedular de Fracturas , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/cirugía , Lesiones del Sistema Vascular/diagnóstico por imagen , Hematoma/etiología , Hematoma/cirugía , Hematoma/diagnóstico por imagen , Angiografía por Tomografía ComputarizadaRESUMEN
BACKGROUND: Cardiac myxomas are the most common type of primary cardiac tumors in adults, but they can have variable features that make them difficult to diagnose. We report two cases of atrial myxoma with calcification or ossification, which are rare pathological subgroups of myxoma. CASE PRESENTATION: A 47-year-old woman and a 35-year-old man presented to our hospital with different symptoms. Both patients had a history of chronic diseases. Transthoracic and transesophageal echocardiography revealed a mass in the left or right atrium, respectively, with strong echogenicity and echogenic shadows. The masses were suspected to be malignant tumors with calcification or ossification. Contrast transthoracic echocardiography(cTEE) showed low blood supply within the lesions. The patients underwent surgical resection of the atrial mass, and the pathology confirmed myxoma with partial ossification or massive calcification. CONCLUSION: We report two rare cases of atrial myxoma with calcification or ossification and analyze their ultrasonographic features. Transthoracic echocardiography and cTEE can provide valuable information for the diagnosis and management of such mass. However, distinguishing calcification and ossification in myxoma from calcification in malignant tumors is challenging. More studies are needed to understand the pathogenesis and imaging characteristics of these myxoma variants.
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Calcinosis , Atrios Cardíacos , Neoplasias Cardíacas , Mixoma , Osificación Heterotópica , Humanos , Mixoma/diagnóstico , Mixoma/cirugía , Mixoma/complicaciones , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Calcinosis/diagnóstico por imagen , Calcinosis/diagnóstico , Calcinosis/cirugía , Atrios Cardíacos/patología , Atrios Cardíacos/diagnóstico por imagen , Femenino , Adulto , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/complicaciones , Osificación Heterotópica/cirugía , Ecocardiografía , Ecocardiografía TransesofágicaRESUMEN
Thoracic ossification of the ligamentum flavum (TOLF) is a pathological heterotopic ossification disease in which the fibrous tissue of the ligamentum flavum of the thoracic spine converts into bony tissue, often leading to thoracic spinal stenosis and compression of the thoracic spinal cord nerve. When TOLF patients present with symptoms of spinal cord nerve compression, surgical treatment is usually required, and traditional open surgery is more invasive and carries a higher risk of spinal cord nerve injury. In recent years, domestic and foreign researchers have tried to apply spinal endoscopic techniques such as microendoscopy, percutaneous foraminoscopy, and unilateral biportal endoscopy for the treatment of TOLF, which can maximize the preservation of normal bone while achieving adequate decompression of the spinal cord nerve, with less damage to spinal stability, and have the advantages of less surgical trauma, less bleeding, and faster postoperative recovery. Due to the special anatomical structure of the thoracic vertebra, spinal endoscopic techniques should focus on safety and it is recommended that they are performed in experienced centers, and surgical indications should be strictly controlled.
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Endoscopía , Ligamento Amarillo , Osificación Heterotópica , Vértebras Torácicas , Humanos , Ligamento Amarillo/cirugía , Osificación Heterotópica/cirugía , Vértebras Torácicas/cirugía , Endoscopía/métodosRESUMEN
In the forearm, posttraumatic heterotopic ossification usually forms as a proximal radioulnar synostosis. It can occur after soft tissue injury involving the interosseous membrane or after surgery involving the radio and ulna, such as distal biceps tendon repair. It can also be induced by radial head dislocation or fracture. Screening radiography can be used to select the appropriate time for excision. The synostosis can be resected when the ectopic bone margin and trabeculation appear mature on radiographs. An interval of 6-12 months from the injury is generally recommended based on ectopic bone maturity. Selection of the surgical approach depends on site, extension (elbow joint or proximal radioulnar joint), severity of the initial articular surface, and periarticular tissue injury. The posterolateral approach is indicated for synostoses: at or distal to the bicipital tuberosity, at the level of the radial head, and proximal radioulnar joint. The posterior global approach is recommended when the forearm synostosis is associated with complete bony ankylosis of the elbow involving the distal aspect of the humerus. After surgical resection of a proximal radioulnar synostosis, the exposed bone surfaces can be covered with interposition material to minimize recurrence.
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Radio (Anatomía) , Sinostosis , Cúbito , Humanos , Cúbito/cirugía , Cúbito/diagnóstico por imagen , Cúbito/anomalías , Radio (Anatomía)/cirugía , Radio (Anatomía)/diagnóstico por imagen , Radio (Anatomía)/anomalías , Sinostosis/cirugía , Osificación Heterotópica/cirugía , Osificación Heterotópica/etiología , Osificación Heterotópica/diagnóstico por imagen , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Radiografía/métodos , Procedimientos Ortopédicos/métodosRESUMEN
To investigate the clinical characteristics of Eagle syndrome (ES) and evaluate psychological distress of the patients. Ten cases of ES were enrolled, clinical characteristics and management were analyzed. Psychological disorders of the patients were assessed by the test of self-rating anxiety scale (SAS) and self-rating depression scale (SDS). There were 8 females and 2 males varying from 34 to 56 years with a mean age of 44.86 ± 8.38 years. The main complaints included foreign body sensation of pharynx, odynophagia, vertigo with turning of the head-neck, pain of anterolateral neck, and toothache. Three cases were right-side affected, 6 cases were left-sided and 1 case was bilateral. Radiographic examination showed the elongated styloid process of bilateral in all cases, however, hypertrophy, improper inclination, abnormal angulation of styloid process and more complete calcification of stylohoid ligament of the complained side were observed compared to the opposite side. Eight cases suffered from anxiety and/or depression. A surgical intervention was carried out on 6 patients to resect the elongated styloid process, the symptoms and mental distress disappeared after the operation and no recurrence was found in their follow-ups. Meticulous interrogation of illness history, proper examination, and radiological studies may be valuable in diagnostic confirmation of ES. It is the hyperostosis, abnormal angulation of the styloid process rather than the simple elongation which is more likely to be attributed to the development of ES. Psychological disorders in ES patients were observed in our study and should be paid more attention in the future research.
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Osificación Heterotópica , Hueso Temporal , Humanos , Femenino , Masculino , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/cirugía , Persona de Mediana Edad , Adulto , Hueso Temporal/anomalías , Hueso Temporal/diagnóstico por imagen , Ansiedad/etiología , Depresión/etiologíaRESUMEN
OBJECTIVE: To compare the radiological outcome and development of heterotopic ossification (HO) following single-segment anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) for cervical disc herniation and evaluate their impact on surgical success. STUDY DESIGN: Descriptive comparative study. Place and Duration of the Study: Neurosurgery Department at Bozyaka Education and Research Hospital, Izmir, Turkiye, between January 2020 and June 2022. METHODOLOGY: Patients aged 18-70 years with radicular neck pain unresponsive to conventional medical treatment and an MRI-confirmed diagnosis were included. Patients with osteoporosis (OP) were excluded. Patients were randomised into two treatment groups (ACDF and CDR) and stratified by age and symptom severity. Radiographic assessments and HO classification according to McAfee were performed. RESULTS: Among the included patients, 56 underwent ACDF and 45 underwent CDR. The mean patient age was 48.29 ± 9.530 and 41.84 ± 7.239 years in the ACDF and CDR groups, respectively (p <0.001). The postoperative disc height increased in both groups. The T1 slope was significantly higher preoperatively and in the early postoperative period in the CDR group than in the ACDF group (p = 0.001). HO was graded as 1, 2, 3, and 4 in 28 (27.7%), 6 (5.9%), 7 (6.9%), and 4 (3%) patients, respectively. CONCLUSION: ACDF and CDR provided similar improvements in radiological measurements and pain relief. Although both procedures significantly enhanced the patient's quality of life and disability scores, HO was more prevalent following CDR during long-term follow-up. KEY WORDS: Cervical disc replacement, Anterior cervical discectomy and fusion, Spinal surgery techniques, Heterotopic ossification.
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Vértebras Cervicales , Discectomía , Desplazamiento del Disco Intervertebral , Fusión Vertebral , Reeemplazo Total de Disco , Humanos , Persona de Mediana Edad , Discectomía/métodos , Masculino , Femenino , Fusión Vertebral/métodos , Adulto , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Reeemplazo Total de Disco/métodos , Desplazamiento del Disco Intervertebral/cirugía , Resultado del Tratamiento , Degeneración del Disco Intervertebral/cirugía , Dolor de Cuello/cirugía , Dolor de Cuello/etiología , Anciano , Osificación Heterotópica/cirugía , Complicaciones Posoperatorias/epidemiología , Adulto Joven , AdolescenteRESUMEN
INTRODUCTION: Neurogenic Heterotopic ossification (NHO) is a potential sequalae and a detrimental complication following neurological insult. It is characterized by formation of localized gradually progressive, peri-articular lamellar bone formation in extra-skeletal tissues. We would like to report a rare case of heterotopic ossification involving all 4 limbs, in which we tried to restore joint mobility to improve his functional status so that he could perform his daily tasks. CASE PRESENTATION: We present a case of a 33-year-old bed ridden male, diagnosed with NHO involving all 4 limbs (bilateral hip, right knee, right shoulder, left elbow). The patient had a crippled posture, significant pain and impaired range of motion hampering movement of all four limbs which prevented him from lying down supine, sitting, walking and performing activities of daily living. After three surgeries, the patient achieved wheelchair mobilization and upright posture with the assistance of calipers. CONCLUSION: The management of NHO requires a multidisciplinary approach involving orthopaedic surgeons, neurologists & rehabilitation specialists. Prognosis of NHO depends on factors such as extent of ossification, underlying neurological condition & patients overall health.
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Osificación Heterotópica , Humanos , Osificación Heterotópica/cirugía , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/complicaciones , Osificación Heterotópica/diagnóstico , Masculino , Adulto , Rango del Movimiento Articular , Actividades Cotidianas , Postura , Resultado del TratamientoRESUMEN
PURPOSE: This study aims to observe the safety and effectiveness of 10-mm endoscopic minimally invasive interlaminar decompression in the treatment of ossified lumbar spinal stenosis. METHODS: The clinical data of 50 consecutive patients with ossified lumbar spinal stenosis were retrospectively analyzed. All patients underwent minimally invasive interlaminar decompression with 10-mm endoscope. Patient demographics, perioperative data, and clinical outcomes were recorded. Visual analog scale scores, Oswestry disability index scores, and modified Macnab criteria were used to assess clinical outcomes. The lateral recess angle, real spinal canal area, and effective intervertebral foramen area were used to assess the effect of decompression. RESULTS: The mean age of all patients was 59.0 ± 12.3 years. The mean operative time and intraoperative blood loss were 43.7 ± 8.7 minutes and <20 ml, respectively. Two years after surgery, the leg pain Visual analog scale score decreased from 7.4 ± 1.0 to 1.6 ± 0.6 (P < 0.05) and the Oswestry disability index score decreased from 63.8 ± 7.6 to 21.7 ± 3.4 (P < 0.05). The lateral recess angle, real spinal canal area and effective intervertebral foramen area were significantly larger than before surgery (P < 0.05). The overall excellent and good rate at the last follow-up was 92.0% according to the modified Macnab criteria. CONCLUSIONS: The 10-mm endoscopic minimally invasive interlaminar decompression can safely and effectively remove the ossification in the spinal canal and achieve adequate decompression in patients with ossified lumbar spinal stenosis.
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Descompresión Quirúrgica , Vértebras Lumbares , Procedimientos Quirúrgicos Mínimamente Invasivos , Estenosis Espinal , Humanos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Persona de Mediana Edad , Femenino , Descompresión Quirúrgica/métodos , Masculino , Vértebras Lumbares/cirugía , Anciano , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Neuroendoscopía/métodos , Osificación Heterotópica/cirugía , Endoscopía/métodos , AdultoRESUMEN
Ossification of the sacrotuberous ligament is a rare occurrence in soft tissue, with only 15 cases reported in the past few decades. We reported two cases of bilateral ossification in sacrotuberous ligaments and provided a concise review of the literature on this pathology. Clinical data, radiographic outcomes, and diagnostic and treatment details were obtained. This study aimed to summarize this disease's characteristics and investigate its pathogenesis through a review of literature from the last thirty years. This condition is often incidentally confirmed in elderly males via imagiological examination or gross anatomy and presents a low morbidity rate. Its pathogenesis may be related to stress concentration, excessive intake of element ions, injury repair, and improper operative technique. The majority of patients may not exhibit any clinical symptoms or signs and typically do not require medical interventions. It may be complicated with pudendal nerve entrapment syndrome. The long-term effects of surgical resection and the most effective treatment approach remain areas for further research.