颈椎后纵韧带骨化症合并硬膜囊骨化的前路手术治疗

目的 探讨颈椎后纵韧带骨化症合并硬膜囊骨化的影像学表现、前路手术方法 及疗效.方法 2005年1月至2008年3月,前路手术治疗颈椎后纵韧带骨化症合并硬膜囊骨化患者13例.男11例,女2例;年龄43～72岁,平均53.6岁.骨化物分型:局限型3例,分节型2例,连续型5例,混合型3例;骨化物范围涉及1～5椎,平均2.8椎.患者均通过前路椎体次全切除术,切除骨化后纵韧带减压,术中6例患者后纵韧带骨化和硬膜囊骨化得以完全分离,硬膜囊保留完整,另7例患者硬膜囊出现不同程度撕裂或缺损.结果 8例患者术前CT横断面成像上表现为典型的"双影征",2例患者表现为整块骨化物存在中心低密度影,余3例患者表现为椎管狭窄率超过90%的严重后纵韧带骨化.术后5例患者并发脑脊液漏,其中3例经卧床休息、局部加压治疗3～5 d后愈合,另2例患者皮肤愈合后形成间歇性脑脊液囊肿,经反复穿刺抽液治疗1个月后痊愈.随访6个月～2年,平均1年,所有患者JOA评分从术前平均8.1分提高至术后平均13.2分,神经功能恢复率平均57.3%.骨化硬膜囊切除和未切除两组患者的神经功能恢复率差异无统计学意义.结论 CT三维重建检查有助于术前诊断后纵韧带骨化合并硬膜囊骨化,合并硬膜囊骨化并非前路手术的禁忌证,前路手术切除骨化后纵韧带、彻底减压是提高此类患者手术疗效的关键.

Anterior surgery for cervical ossification of the posterior longitudinal ligament associated with dural ossification

Objective To discuss the radiologieal characteristics, surgical treatment and clinical re-sults of ossification of the posterior longitudinal ligament (OPLL) associated with dural ossification (DO) in the cervical spine. Methods Between January 2005 and March 2008, 13 patients (11 males and 2 females,age ranging 43-72 years, mean 53.6 years) with OPLL was found to be associated with DO in anterior ap-proach. The type of OPLL was distributed as follows: three local-type, two segmental-type, five continuous-type, and three mixed-type. The OPLL extended 1-5 vertebrae, with an average of 2.8 vertebrae. All patients underwent anterior eorpectomy and resection of OPLL. During operation, the dura mater was dissected and remained intact in six patients and tore or defected in other seven patients. Results Eight patients were presented with typical double-layer sign in preoperative CT scans, two patients with a low-intensity in the whole ossification, and the occupying rate of OPLL exceeding 90% in other three patients. Five patients de-veloped eerebrospinal fluid (CSF) leakage, and three patients healed after staying in bed and local pressure for 3-5 days. The other two patients experienced a CSF pseudocyst, which gradually disappeared after 1 month of repeated puncture and aspiration. After a follow-up of six months to two years (mean, one year), the mean JOA score increased from 8.1 points before operation to 13.2 points after operation, and the mean im-provement rate of neurological status was 57.3%. There was no significant difference in neurological im-provement between the patients with or without DO removed. Conclusion Preoperative CT three-dimension-al reconstruction was helpful to diagnose OPLL associated with DO in the cervical spine before operation. O-PLL associated with DO was not the contraindication to the anterior approach for OPLL. Removal of ossifica-tion and complete decompression were critical to the surgical results in anterior approach.