Ossification of the posterior longitudinal ligament (OPLL) is a condition found predominantly in the oriental population and is rarely seen in non orientals. OPLL can present with cervical canal stenosis and myelopathy (including central cord syndrome), often following minor trauma. Co-existence of OPLL with diffuse idiopathic skeletal hyperostosis (DISH) is a rare condition and very few reports of such patients exist in literature. Here we report the case of a Caucasian with co-existing DISH and OPLL, presenting with acute central cord syndrome associated with fracture of the ossification. A 64 year old Caucasian farmer was transferred to our spinal unit with weakness in the right upper limb following a road traffic accident. On examination he had hyperaesthesia in both upper limbs and motor power of grade 4 in the right upper limb with a distal motor power of grade 3 in the hand. There was no motor deficit in the left upper limb or lower limbs. Radiographs revealed an ossification of the posterior longitudinal ligament with a break at C2 and C3 levels. He also had exuberant soft tissue ossification in the cervical and thoracic spines, suggestive of diffuse idiopathic skeletal hyperostosis (DISH). He recovered completely in 6 weeks with non operative treatment. Fracture of the posterior longitudinal ligament has not been widely reported, although it is possibly more prevalent than is recognised. We report this case in order to highlight the importance of recognising this condition in non oriental populations and to demonstrate that non operative treatment has a good prognosis

Background. Heterotopic ossification (HO) is a known complication following total hip arthroplasty, with increased incidence in certain patient populations. Current prophylaxis options include oral non-steroidal anti-inflammatory drugs (NSAIDs) and radiation therapy, but an optimal radiation protocol has yet to be clearly defined. We performed a randomized, double-blinded clinical trial in high-risk total hip arthroplasty patients to determine the efficacy of 400 cGy versus 700 cGy doses of radiation. Methods. 147 patients at high risk for HO undergoing total hip arthroplasty (THA) at Rush-St. Luke's- Presbyterian medical center were randomized to either a single 400 cGy or 700 cGy dose of radiation. High risk was defined as diagnosis of diffuse idiopathic skeletal hyperostosis (DISH), hypertrophic osteoarthritis, ankylosing spondylitis, or history of previous heterotopic ossification. Radiation was administered over a 14 × 6 cm area of soft tissue and given on the first or second post-operative day. A blinded reviewer graded anterior-posterior (AP) and lateral radiographs taken immediately post-operatively and at a minimum of 6 months post-operatively. Progression was defined as an increase in Brooker classification from the immediate post-operative to the long-term post-operative radiograph. Operative data including surgical approach, use of cemented implants, revision surgery, and post-operative range of motion data were also collected. Results. A significantly greater portion of patients who received the 400 cGy dose demonstrated progression of HO than patients who received the 700 cGy dose. No pre-operative factors were associated with a higher rate of progression. Patients who progressed had less flexion on physical exam than patients who did not progress, but this was not clinically significant. Conclusion. To the authors' knowledge this is the largest randomized prospective study to date comparing two single-dosages of radiation treatment. 700 cGy demonstrates superiority over 400 cGy in preventing HO formation following total hip arthroplasty in high-risk patients and may be the more effective treatment in this population

Introduction: Described by Jacques Forrestier at the beginning of the 20th century, the disease was named ankylosing hyperostosis of the spine. 1. Since that time various other names have been accorded to it, the most comprehensive being dish: diffuse, idiopathic, skeletal, hyperostosis. 2. The disease is often misdiagnosed by radiologists, unrecognised by surgeons and considered a silent condition. To diffuse this myth of ‘innocence ‘ I am presenting syndromes collected from over 80 patients, during some 20 years. Methods: the clinical syndromes were recorded, with emphasis on general health and family history. The physical examination recorded the rigidity of spinal movements and neurological changes. All patients were exposed to plain films and CT scan of the spine, to barium meal and /or laryngoscopy. Results: Only clinical assessment and radiological illustrations were the aim of this review: Cervical syndromes: – painful ankylosis; stenosis with myelopathy (. 3. );. -Tracheal compression with laryngeal nerve palsy;. -Esophageal compression with endoscopic implications. (. 4. ). Dorsal syndromes: painful ankylosis, spinal stenosis & myelopathy (. 5. ,. 6. ,);. Lumbar syndromes: painful hyperlordotic ankylosis, spinal stenosis (. 7. );. Sacroiliac fusion (. 8. ); calcifications of iliosacral and iliolumbar ligaments. Extra spinal calcifications: peri articular at elbow, hips and in operative scars: Achilles’ repair; Post-laparatomy abdominal wall ossification (. 9. ). Particular features: early onset (age 40); incidence in families with two brothers and another with three brothers. Discussion: Presentation of multilevel spinal syndromes and extra-spinal symptomatic calcification/ossification is intended to dispel the “innocence” of this disease. Except the ankylosis, often asymptomatic, the approximate symptomatic disease was found to be of 10%

The April 2015 Spine Roundup360 looks at: Hyperostotic spine in injury; App based back pain control; Interspinous process devices should be avoided in claudication; Robot assisted pedicle screws: fad or advance?; Vancomycin antibiotic power in spinal surgery; What to do with that burst fracture?; Increasing complexity of spinal fractures in major trauma pathways; Vitamin D and spinal fractures