IJCRR - 5(21), November, 2013
Pages: 47-49
Date of Publication: 21-Nov-2013
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OSSIFICATION OF ANTERIOR LONGITUDINAL LIGAMENT IN THORACIC VERTEBRAE - A CASE REPORT
Author: Nagaraj Mallashetty, B.M. Bannur, Preetish Endigeri, O.B. Pattanashetty, Pramod Sangolgi
Category: Healthcare
Abstract:During the routine examination of dry and processed bones, it was observed that the bodies' thoracic vertebrae were fused due to the ossification of anterior longitudinal ligament. The posterior longitudinal ligament, ligamentum flavum and intervertebral disc were spared. The ossification of anterior longitudinal ligament is considered as a part of diffuse idiopathic skeletal hyperostosis \? DISH( Forestier's disease), most common in the age group of 40 and more who are obese leading to mild to moderate restriction of joint movement, low back pain and stiffness.
Keywords: ossification, longitudinal ligament, forestiers disease, vertebrae
Full Text:
INTRODUCTION
The human vertebral column consists of 33 vertebrae. 7- cervical, 12 - thoracic, 5 - lumbar, 5 - sacral, and 4 - coccygeal. Among these five sacral vertebrae fuse to form sacrum and 4 coccygeal bones fuse to form one coccyx.
The vertebrae are held together by muscles and strong ligaments like anterior longitudinal and posterior longitudinal ligaments. Anterior longitudinal ligament extends from atlas to sacrum and it is a flat strong band found along the anterior surface of vertebral bodies. 1
In the present study the bodies of upper ten thoracic vertebrae were fused due to ossification of anterior longitudinal ligament.
CASE REPORT
During the routine examination of dry and processed bones in the department of Anatomy, Shri B.M.Patil Medical College, we observed that the bodies of upper ten thoracic vertebrae were fused due to ossification of anterior longitudinal ligament.
A clear space was noted between the mass and the vertebral bodies. The intervertebral disc space was found to be maintained and zygoapophyseal joints were found to be free. The intervertebral foraminae and vertebral canal appeared normal.
DISCUSSION
The present observation of ossification of anterior longitudinal ligament on the anterior aspect of thoracic vertebral bodies, with maintained disc space, favor the diagnosis of Forestier’s disease, otherwise known as Diffuse Idiopathic skeletal hyperostosis (DISH).
DISH commonly involves the thoracic and lumbar vertebrae. Foresteir’s disease most commonly affects obese men who are more than 40 years old. The prevalence of the disease has been estimated to range between 12 and 22% in men and 12 to 13% in women. Most patients have mild to moderate restriction of spine movements, low back pain and stiffness in the lumbosacral region.3
The Forestier’s disease is diagnosed and differentiated from ankylosing spondylitis, on the basis of certain radiological criteria. Calcification and ossification along the anterolateral borders of vertebral bodies and preservation of the integrity
of the intervertebral disc, without diminution of disc spaces and facet joints remain unaffected1.
The ossification pattern of DISH involves the anterior ligament, the lateral portion of the annulus fibrosis, and the adjacent vertebral bodies.
Ankylosing spondylitis is a genetic disease with identifiable marks and involvement of organs. DISH has no genetic link and no organ involvement.4
DISH is an abnormality in which abnormal ossification occurs along the ligaments.5 The incidence of this disease is about 6-12% and most common in males. Usually occurs in elder people after 50 years of age. But coakely et al., had observed it in paediatric cases.6
The cacification and ossification is most common in right side of spine than left. In patients with dextrocardia this calcification occurs on left side, which confirms the role of the descending thoracic aorta in preventing the physical manifestation of DISH on one side of spine4
The exact etiology is unknown. Mechanical factor, dietary and long term use of antidepressants may be correlated with DISH. The disease is not fatal however some complications may lead to death such as paralysis, dysphagia and pulmonary infections due to fusion of rib cage.
Ossification of posterior longitudinal ligament has been well recognized as Japanese disease and it is a well documented cause of cervical spine stenosis. It occurs after the age of 40years and most commonly affected region is cervical spine, although thoracic and lumbar regions are not exempt. the frequency of involvement decreases as the level descends as follows: cervical 70-75%,thoracic 15-20% and lumbar 10%. most of the cases are asymptomatic. Some may present with cervical radiculomyopathy along with spastic palsy of extremities which depends on thickness ossification of ligament.7
CONCLUSION
In the present study it was observed that, there was fusion of the bodies of thoracic vertebrae due to ossification of anterior longitudinal ligament and it is a part of Diffuse Idiopathic Skeletal Hyperostosis which should be differentiated from ankylosing spondylitis as both have different etiology and treatment.
ACKNOWLEDGEMENT
Authors acknowledge the help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors /publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. . Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
References:
- Sinnatamby C S (1999) Last’s Anatomy – Regional and applied. 10th edition. UK; Churchil Livingstone. 414-421.
- KhoziamN, Grays(2009) Diffuse Idiopathic Skeletal Hyperostosis, e- medical Radiology /article/388973- overview
- Burkus JK, Denis F(1994) Hyperextension injuries of thoracic spine in Diffuse Idiopathic Skeletal Hyperostosis; J Bone Joint Surg Am, 76; 237-24
- Forestier,j Lagier R(1951).Ankylosing hyperostosis of the spine.:clin.orthop.;74-75
- Mccafferty RR,HarrisonMJ,(1991) ossification of anterior longitudinal ligament and forestiers disease:an analysis of seven cases.J Neurosurg,85:524-525
- Coakley FV, vive J,(1995)childhood ossification of anterior longitudinal ligament of cervical spine.clin radiol,50:115-116
- M Khalid,(2000) ossification of posterior longitudinal ligament presenting as cervical myelopathy:In J Radiology and imaging.10:253-254
- Maheshwari J(2005) Essential Orthopedics Text Book, 3rd Edition, New Delhi; Mehta publications Pvt Ltd. 248-249.
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