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Cervical Myelopathy by C1 Posterior Tubercle Impingement in a Patient With DISH

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Title: Cervical Myelopathy by C1 Posterior Tubercle Impingement in a Patient With DISH
Authors: Kawabori, Masahito Browse this author →KAKEN DB
Hida, Kazutoshi Browse this author →KAKEN DB
Akino, Minoru Browse this author
Yano, Shunsuke Browse this author
Saito, Hisatoshi Browse this author
Iwasaki, Yoshinobu Browse this author
Keywords: Diffuse idiopathic skeletal hyperostosis
ossification of posterior longitudinal ligament
posterior tubercle of atlas
Issue Date: 1-Sep-2009
Publisher: Lippincott Williams & Wilkins
Journal Title: Spine
Volume: 34
Issue: 19
Start Page: E709
End Page: E711
Publisher DOI: 10.1097/BRS.0b013e3181aa26a4
PMID: 19730204
Abstract: Study Design. A unique case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) associated with C1 posterior tubercle impingement resulting in spinal canal stenosis and cervical myelopathy. Objective. To describe an uncommon mechanism of spinal cord compression in patient with DISH. Summary of Background Data. The neurological deficits due to cervical DISH are relatively rare and a few cases of cervical spinal cord compression due to atlantoaxial subluxation, odontoid fracture, pseudotumor, ligamentous hypertrophy and basilar impression have been reported. To the best of our knowledge, there has been no other report of a patient with DISH causing C1 posterior tubercle impingement and cervical myelopathy. Methods. 75-year-old Japanese man, first diagnosed as hyperostosis of anterior and posterior longitudinal ligament 25 years ago, presented with gradual progression of numbness in both lower extremities, disturbed precise hand motion and urinary function. DISH, OPLL, and C1 posterior tubercle impingement was diagnosed by radiograph, CT, and MRI. Hyperintense signal in the C1 spinal cord on T2 weighted sequence was observed. Result. Laminectomy from C1 to C3 was performed. Myelocompression and myelopathy improved after the surgical intervention. Multilevel fusion of the subaxial cervical spine and increase of the mechanical stress on the craniocervical segment may leads to partial damage of the ligaments and resulted in C1 posterior arch impingement. Conclusion. This is the first report of unique C1 posterior tubercle impingement and myelopathy caused by DISH. We should keep it in mind that DISH can cause serious problems in the upper cervical spine even after 25 years of interval.
Rights: This is a non-final version of an article published in final form in Kawabori, Masahito; Hida, Kazutoshi; Akino, Minoru; Yano, Shunsuke; Saito, Hisatoshi; Iwasaki, Yoshinobu; Cervical Myelopathy by C1 Posterior Tubercle Impingement in a Patient With DISH, Spin, 34(19), pp.E709-E711, 2009.
Type: article (author version)
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 川堀 真人

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