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Myelopathy by Lesions of the Craniocervical Junction in a Patient With Forestier Disease

Pascal-Moussellard, Hugues, MD*; Drossard, Guillaume, MD; Cursolles, Jean-Christophe, MD; Catonné, Yves, PhD*; Smadja, Didier, PhD

doi: 10.1097/01.brs.0000225972.24608.be
Case Report
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Study Design. The authors report a case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) associated with basilar impression resulting in tetraparesis.

Objective. To describe neurologic compromise associated with DISH.

Summary of Background Data. Neurologic deficits due to DISH are very rare, and only 1 case of basilar impression associated with DISH has previously been reported in the literature.

Methods. Diagnosis was confirmed by radiograph and MRI, which demonstrated basilar impression associated with a hyperintense signal in the spinal cord on T2-weighted sequences. Transoral resection of the dens associated with posterior occipitocervical fixation was performed during the same anesthesia.

Results. Postoperative outcome demonstrated regression of the pyramidal signs without recovery of unassisted walking.

Conclusion. Early MRI should be performed in the evidence of spinal cord suffering in patients with DISH. Transoral approach allowed a good decompression of the spinal cord.

Neurologic deficit due to diffuse idiopathic skeletal hyperostosis are very rare. The authors report a case of a patient with diffuse idiopathic skeletal hyperostosis associated with basilar impression resulting in tetraparesis. Transoral resection of the dens associated with posterior occipitocervical fixation was performed, allowing decompression of the spinal cord and partial neurologic recovery.

From the *Service Orthopédie Pr. Saillant, CHU Pitié-Salpétrière, Paris; †Service Orthopédie and ‡Service Neurologie, CHU La Meynard, Fort de France, Martinique.

Acknowledgment date: March 29, 2005. First revision date: January 18, 2006. Acceptance date: January 25, 2006.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Hugues Pascal-Moussellard, MD, Service Orthopédie Pr. Saillant, Pavillon Gaston Cordier, CHU Pitié-Salpétrière, Bd de l'Hopital, 75013 Paris, France; E-mail: hpmous@sasi.fr

© 2006 Lippincott Williams & Wilkins, Inc.