Minimally Invasive Surgical Management of Thoracic Ossification of the Ligamentum Flavum Associated with X-linked Hypophosphatemia

Riccio, Alexander R.; Entezami, Pouya; Giuffrida, A. Ylenia; Dowling, John P.; Forrest, George; German, John W.

doi:10.1016/j.wneu.2016.07.076

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…However, surgery can be challenging particularly in the setting of ossification of the ligamentum flavum and posterior longitudinal ligaments, where CSF leak is not uncommon. Recently, a minimally invasive technique for multi-level thoracic cord decompression has been reported but surgical experience remains limited (Riccio et al 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Outcome of adult patients with X‐linked hypophosphatemia caused by PHEX gene mutations

Chesher

Oddy

Darbar

et al. 2018

J of Inher Metab Disea

112

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X-linked hypophosphatemia (XLH) is the most common monogenic disorder causing hypophosphatemia. This case-note review documents the clinical features and the complications of treatment in 59 adults (19 male, 40 female) with XLH. XLH is associated with a large number of private mutations; 37 different mutations in the PHEX gene were identified in this cohort, 14 of which have not been previously reported. Orthopaedic involvement requiring surgical intervention (osteotomy) was frequent. Joint replacement and decompressive laminectomy were observed in those older than 40 years. Dental disease (63%), nephrocalcinosis (42%), and hearing impairment (14%) were also common. The rarity of the disease and the large number of variants make it difficult to discern specific genotype-phenotype relationships. A new treatment, an anti-FGF23 antibody, that may affect the natural history of the disease is currently being investigated in clinical trials.Electronic supplementary materialThe online version of this article (10.1007/s10545-018-0147-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Outcome of adult patients with X‐linked hypophosphatemia caused by PHEX gene mutations

Chesher

Oddy

Darbar

et al. 2018

J of Inher Metab Disea

112

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“…Up to 59% of children showed complete or partial sagittal suture fusion and 25% showed Chiari malformation type 1 in a recent large retrospective cohort study, however, most patients were asymptomatic (179). Rarely, symptomatic spinal enthesopathy or ossification of the posterior longitudinal spinal ligament may requiring laminoplasty, laminectomy or posterior decompression surgery (180)(181)(182)(183).…”

Section: Surgical Managementmentioning

confidence: 99%

Consensus Recommendations for the Diagnosis and Management of X-Linked Hypophosphatemia in Belgium

et al. 2021

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X-linked hypophosphatemia (XLH) is the most common genetic form of hypophosphatemic rickets and osteomalacia. In this disease, mutations in the PHEX gene lead to elevated levels of the hormone fibroblast growth factor 23 (FGF23), resulting in renal phosphate wasting and impaired skeletal and dental mineralization. Recently, international guidelines for the diagnosis and treatment of this condition have been published. However, more specific recommendations are needed to provide guidance at the national level, considering resource availability and health economic aspects. A national multidisciplinary group of Belgian experts convened to discuss translation of international best available evidence into locally feasible consensus recommendations. Patients with XLH may present to a wide array of primary, secondary and tertiary care physicians, among whom awareness of the disease should be raised. XLH has a very broad differential-diagnosis for which clinical features, biochemical and genetic testing in centers of expertise are recommended. Optimal care requires a multidisciplinary approach, guided by an expert in metabolic bone diseases and involving (according to the individual patient’s needs) pediatric and adult medical specialties and paramedical caregivers, including but not limited to general practitioners, dentists, radiologists and orthopedic surgeons. In children with severe or refractory symptoms, FGF23 inhibition using burosumab may provide superior outcomes compared to conventional medical therapy with phosphate supplements and active vitamin D analogues. Burosumab has also demonstrated promising results in adults on certain clinical outcomes such as pseudofractures. In summary, this work outlines recommendations for clinicians and policymakers, with a vision for improving the diagnostic and therapeutic landscape for XLH patients in Belgium.

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“…First described as a clinical condition in the 1920s, 33 OLF has since been reported as an important cause of thoracic spinal myelopathy. [34][35][36][37] Reports focused on OLF are increasing outside of East Asia as reported case numbers continue to climb. 38,39 Some reports have indicated that a range of factors including genetics, metabolic abnormalities, inflammation, and mechanical stress contribute to TOLF incidence and progression.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification

Ye,

Guo,

et al. 2023

Spine

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Study Design. Systematic review and meta-analysis. Objective. This study systematically reviewed and evaluated the safety and efficacy of spinal endoscopic techniques as a treatment for thoracic ligamentum flavum ossification (TOLF). Summary of Background Data. The use of spinal endoscopic techniques for the treatment of TOLF has increased in recent years. The present study is the first comprehensive systematic review and meta-analysis focused on the use of spinal endoscopic techniques for TOLF. Methods. The Cochrane Central, PubMed, Web of Science, and Embase databases were systematically searched for studies focused on patients undergoing spinal endoscopic techniques to treat symptomatic TOLF. Results. This meta-analysis included 23 studies. We included 323 patients (177 males, 146 females) with a mean age of 58.40±10.06 years, with 304 total recorded lesion locations of which 245 were located in the lower thoracic spine. Complications affected 35/323 patients, and the mean operative duration for 305 patients was 108.15±47.34 minutes. For 187 patients, the mean operative bleeding was 25.13±12.54 mL, while for 87 patients the mean duration of hospitalization was 4.59±1.93 days. At last follow-up，functional assessment was performed for 260 patients, of whom 200 were in excellent condition, visual analog scale (VAS) scores were assessed for 160 patients, with a mean improvement of 4.40 (3.95,4.86) Japanese Orthopedic Association (JOA) scores were recorded for 115 patients, with a mean improvement of 2.99 (2.77,3.22) , and modified Japanese Orthopedic Association (mJOA) scores were recorded for 208 patients, with a mean improvement of 3.41 (3.17,3.64) . Conclusions. These results support several advantages of spinal endoscopic techniques for the treatment of symptomatic TOLF. These include low complication rates, rapid postoperative recovery, and good functional recovery when used for single-segment, non-nodular ossification and no combined dural ossification.

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Minimally Invasive Surgical Management of Thoracic Ossification of the Ligamentum Flavum Associated with X-linked Hypophosphatemia

Cited by 11 publications

References 19 publications

Outcome of adult patients with X‐linked hypophosphatemia caused by PHEX gene mutations

Outcome of adult patients with X‐linked hypophosphatemia caused by PHEX gene mutations

Consensus Recommendations for the Diagnosis and Management of X-Linked Hypophosphatemia in Belgium

Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification

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