CT findings of ossification of the posterior longitudinal ligament (OPLL), with special emphasis on the relationship to clinical symptoms

To analyze the CT findings of OPLL quantitatively, stenotic rate (thickness of OPLL/A-P diameter of the spinal canal) and occupying rate (area occupied by OPLL/area of spinal canal) were correlated with severity of the myelopathy. The cervical vertebrae were most frequently involved (88.9%). The shapes of OPPL on lateral plain radiography were various but there were slightly more continuous and mixed types than segmented or protrusion types in this series. When the occupying rate exceeded 20%, myelopathy tended to appear. And when the stenotic rate became over 30%, myelopathy tended to appear. There was statistically significant tendency that the higher the stenotic rate or patient had. Therefore we concluded the stenotic rate and occupying rate were useful indicators to evaluate the severity of OPLL.     

Sagittal splitting laminoplasty for spinal canal enlargement for ossification of the spinal ligaments (OPLL and OLF)

Patients have been followed up radiologically after sagittal splitting laminoplasty (SSL) for ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum. The enlarged spinal canal was maintained satisfactorily in all the cases, and the posterior spinal elements were also almost completely restored. In most cases, the range of the vertebral motion was good with more than 50% of the preoperative status. Postoperative instability of the vertebral column was not identified in any case. Mild cervical kyphosis was noted in 6% of cervical OPLL patients. There were no patients with neurological deterioration. Using SSL, reconstruction and restoration of the posterior spinal elements and retention of the enlarged spinal canal were accomplished safely and adequately.     

Rheumatoid arthritis: epidural enhancement as an underestimated cause of subaxial cervical spinal stenosis

PURPOSE: To assess the frequency and site of subaxial spinal canal stenosis due to enhancing tissue in patients with rheumatoid arthritis. MATERIALS AND METHODS: Data from 33 consecutive patients with rheumatoid arthritis were evaluated; these patients had undergone 1.5-T magnetic resonance imaging following gadolinium chelate administration, in combination with a frequency selective fat-suppression technique. Stenosis and enhancement were scored for each of six cervical spinal levels and were compared with results in a control population consisting of 16 patients with degenerative disease. Enhancement was scored as superficial or deep on the anterior and posterior sides from the cervical spinal cord. Differences between patient groups were tested by using the chi(2) test for trend and the Fisher exact test. RESULTS: No significant difference was found in the frequency or severity of subaxial stenosis between rheumatoid arthritis and degenerative disease. Deep epidural enhancement was observed more often with rheumatoid arthritis than with degenerative disease both anterior (25 of 33 patients vs seven of 16 patients, respectively; P <.001) and posterior (24 of 33 patients vs two of 16 patients, respectively; P =.001) to the spinal cord. Enhancing stenosing tissue in rheumatoid arthritis frequently occurred anterior and posterior at the same time and at the same level, with segmental cufflike extension of enhancing tissue around the dural sac. Stenosing tissue enhanced more frequently with rheumatoid arthritis than with degenerative disease (22 of 33 vs four of 16 patients, respectively; P =.008). CONCLUSION: In patients with rheumatoid arthritis, subaxial stenosis is frequently caused by enhancing epidural tissue. This enhancing tissue presumably represents pannus.     

Spinal stenosis subsequent to juvenile lumbar osteochondrosis

This paper describes eight patients with spinal stenosis associated with marked osteochondrous changes in the vertebral bodies due to juvenile lumbar osteochondrosis (Scheuermann's disease). In no case was the midsagittal or interpedicular diameter of the spinal canal indicative of bony stenosis. On the other hand, in the myelograms the sagittal diameter of the dural sac was in all cases significantly narrowed, a diagnostic sign of central spinal stenosis. Therefore, myelography should always be contemplated when osteochondrous changes are present and spinal stenosis is suspected clinically regardless of whether the spinal canal diameters are normal in plain films.     

腰椎管狭窄症31例诊断与治疗

目的　探讨腰椎管狭窄症的诊断与治疗。方法　对 3 1例手术患者临床资料进行分析。结果　本组 3 1例均为继发性腰椎管狭窄 ,其中 2 9例为退行性变型。 2 3 % (7/ 3 1 )同时合并颈、胸椎管狭窄。 2 9% (9/ 3 1 )合并椎间盘突出。椎管造影优点多。治疗中存在误区。结论　椎管造影是不可取代的腰椎管狭窄症诊断方法。避免重手法推拿按摩或大重量牵引和反复椎管内封闭 ,合并颈、胸椎管狭窄者需分期手术。充分、彻底减压特别不能忽略侧椎管狭窄是提高疗效的关键     

颈椎后纵韧带骨化的CT诊断与临床分析

本文报告３９例颈椎后纵韧带骨化病症。临床表现为不同程度的脊髓损害，全部病例作了颈椎ＣＴ扫描，其中２０例进行脊椎造影ＣＴ检查，均显示有椎管狭窄及脊髓受压的征象，并对其病因、ＣＴ诊断价值进行了讨论。     

脊柱结核CT诊断价值(附56例分析)

目的:探讨分析脊柱结核的CT表现及诊断价值。方法:利用螺旋CT对有脊柱结核的56例患者进行扫描。结果:56例有不同程度的骨质破坏、椎旁软组织肿胀、腰大肌脓肿,死骨形成,椎间盘破坏及椎管狭窄。结论:螺旋CT扫描图像清晰,分辨率高,能显示X线检查难以发现的骨质破坏,揭示病变范围及其对椎管的累及程度,有助于对病变的术前评价和术后分析。     

Assessment of the narrow cervical spinal canal: A prospective comparison of MRI,myelography and CT-myelography

This study was designed to compare the accuracy of magnetic resonance imaging (MRI), myelography and computed tomography in the assessment of degenerative cervical spinal stenosis. We prospectively examined a total of 75 spinal segments in 18 patients with suspected cervical spinal canal stenosis, using sagittal spin-echo and axial gradient-echo sequences generated by a 1.5 Tesla imager, conventional myelography, and computed tomography with intrathecal contrast medium (CT-myelography). The degree of stenosis was often overestimated using MRI. This error was most prominent in cases of severe stenosis but was significant with minor to moderate stenosis. In these cases, the clinical consequences of such an overestimation can be serious, because treatment is misdirected. The error is probably caused by pulsation of the cerebrospinal fluid and truncation artefact (Gibbs phenomenon). MRI at 1.5 Tesla is thus frequently inadequate for diagnostic assessment of degenerative cervical spinal stenosis. Myelography and myelographic CT are still useful for decisions on operative treatment, especially in cases of moderate stenosis. This may, however, not apply to imagers operating at 0.5 Tesla as below.     

Bone scanning in Ewing's sarcoma

This is a retrospective analysis of bone scans in 72 patients with Ewing's sarcoma. Sites of primary disease were found to be evenly distributed among the axial skeleton and the proximal and distal extremities. Primary disease sites in the axial skeleton were more frequently associated with metastases. Fifty-three of these patients had their first scans done at presentation; among them, 25 were found to have metastases. Unsuspected metastases were picked up in 28 of all the patients. Metastases at presentation were seen to be associated with a poorer prognosis.     

继发椎管狭窄与脊髓亚急性联合变性MRI异常信号的相关性

目的：研究脊髓亚急性联合变性(SCD)的 MRI 表现特点,探讨继发椎管相对狭窄与 SCD 的 MR 异常信号的相关性。方法收集56例 SCD 患者的临床及 MRI 影像资料,分析 SCD 病例中椎间盘膨出/突出、黄韧带增厚、后纵韧带增厚或两者以上协同作用下的椎管相对狭窄与脊髓内病灶的表现特点。结果56例 SCD 患者中,MRI 检查脊髓表现有病灶的45例,均表现为典型的SCD 影像表现。继发椎管相对狭窄并脊髓信号异常者37例,继发椎管相对狭窄脊髓未见异常信号者2例,无继发椎管相对狭窄脊髓信号异常者8例,无继发椎管相对狭窄脊髓也未见异常信号者9例。比较采用χ2检验统计继发椎管相对狭窄与脊髓异常信号有显著性差异(P <0.05)。37例 SCD 有继发椎管相对狭窄中15例行物理治疗后较对照组病程缩短。结论继发椎管相对狭窄致脊髓微循环障碍是导致 SCD 脊髓病变 MRI 表现更显著或更易于显现的重要因素。     

+Gz associated stenosis of the cervical spinal canal in fighter pilots

Previous magnetic resonance imaging (MRI) studies have shown that repeated exposure to +Gz forces can cause premature degenerative changes of the cervical spine (i.e. a work-related disease). This paper reports on two clinical cases of +Gz-associated degenerative cervical spinal stenosis caused by dorsal osteophytes in fighter pilots. Conventional x-rays and MRI were used to demonstrate narrowing of the cervical spinal canal. The first case was complicated by a C6-7 intervertebral disk prolapse and a congenitally narrow spinal canal. The second case involved progressive degenerative spinal stenosis in the C5-6 disk space which required surgery. The findings in this case were confirmed by surgery which showed posterior osteophytes and thickened ligaments compressing the cervical medulla. These two cases suggest that +Gz forces can cause degenerative spinal stenosis of the cervical spine. Flight safety may be jeopardized if symptoms and signs of medullar compression occur during high +Gz stress. It is recommended that student fighter pilots undergo conventional x-rays and MRI studies in order to screen out and reject candidates with a congenitally narrow spinal canal. These examination methods might be useful in fighter pilots' periodic medical check-ups in order to reveal acquired degenerative spinal stenosis.     

Spinal stenosis

Space conditions in the spine canal play the decisive role in the origin of neurological difficulties connected with pressure on the spinal cord and its radices. For the diagnosis of spinal stenosis the dimensions of the spine canal are of importance: sagital, interpedicular, interarticular and the width of lateral recessus of the spine canal. The diagnostics of spinal stenosis is based on the anterior-posterior and lateral picture of the spine, CT examination and contrast examination of the spine canal--myeloradiculography. CT is included in the diagnostic algorhythm on the 2nd place after picture of the spine in classical projections. The anvantage of CT in its non-invasiveness, illustration without projection distortion and high sensitivity and specificity of the examination. Myeloradiculography is indicated for cases of uncertain findings with CT or discrepancy of the CT picture and clinical condition. It may be presumed that in the near future the CT examination will be required in the diagnosis of spine stenosis more frequently by the physicians.     

Paravertebral ligamentous ossification: DISH,OPLL and OLF

This is an overview of paravertebral ligamentous ossification based on our 5-year experience in ossification of posterior longitudinal ligament (109 cases) and ossification of ligamentum flavum (18 cases). Paravertebral ligamentous ossification is designated as the disorder caused by frequently coexisting ossification of paravertebral ligaments, DISH, OPLL, and OLF. The frequency of the occurrence of isolated ossification of PLL and OLF in Japan is still uncertain. DISH, which is not rare in Europe or North America, is frequently associated with ossification of the posterior aspect of the vertebral bodies, but it may be less symptomatic. The major cause of the probably higher incidence of symptomatic patients in Japan may be due to associated narrowing of the spinal canal.     

CT and MRI characteristics of ossification of the ligamenta flava in the thoracic spine

The purpose of this study was to compare MRI findings with CT findings of mass-forming calcification/ossification of the thoracic ligamenta flava (OTLF). Twenty-one Chinese patients presented with clinical evidence of chronic and progressive thoracic spinal cord compression which included: difficulty in walking; weakness; and/or numbness of the extremities, back pain, and lower extremity paresthesias. Axial and sagittal T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) were performed through the thoracic spine on a 1.0-T Impact unit (Siemens, Erlangen, Germany). Axial CT was obtained with 5-mm contiguous sections through the thoracic region. Decompressive surgery with resection of the OTLF were carried out in all patients. Low signal intensity of the mass-forming OTLF was demonstrated at a single level (n=1) or at multiple levels (n=20) on both T1WI and T2WI. The distribution of OTLF was bilateral at all levels identified in 6 cases, unilateral at all levels in 5 patients, and both unilateral and bilateral at different levels in 10 cases. Ossification of the thoracic ligamenta flava involved the upper thoracic spine (T1-4) in 3 cases, midthoracic spine (T5-8) in 3 cases, lower thoracic spine (T9-12) in 10 cases, and more than one thoracic spinal subregion in 5 cases. Computed tomography confirmed the MR findings regarding the location and distribution of OTLF in all cases, as well as the associated evidence of central spinal canal stenosis. In addition, 5 patients revealed associated ossification of the posterior longitudinal ligament. All patients demonstrated gradual, but incomplete, clinical improvement of the radiculomyelopathy following decompressive surgery. Ossification of the posterior longitudinal ligament resulting in thoracic central spinal canal stenosis and clinical radiculomyelopathy is not uncommon in the Asian people. Ossification of the thoracic ligamenta flava can be accurately evaluated equally well by CT and MR with regard to level(s) and side(s) of involvement, as well as to the relative degree of central spinal canal stenosis and the associated compression of the thoracic spinal cord.     

Spinal cord concussion in rugby players

During an analysis of a group of 40 rugby players who had sustained cervical spinal cord injury, 9 players were identified who had sustained only transient paralysis. These players showed no radiologic evidence of any injury to the cervical spine. We did a retrospective analysis of the clinical and radiological findings in this group of rugby players. The cervical spine radiographs were analyzed for evidence of spinal stenosis, congenital anomalies, and degenerative disk disease. Using the ratio method of assessment for spinal stenosis, we found spinal canal narrowing maximally at C-3 and C-4 in five of the nine players. In the remaining four players, one showed evidence of osteoarthritic change at two levels while another had congenital fusion of two vertebral bodies. In two players, no radiologic evidence of any abnormality was detected. The mechanism of transient disturbance of the spinal cord function after trauma is discussed here.     

Spontaneous resolution of spinal canal deformity after burst-dispersion fracture

We reviewed the records of 28 patients with 30 burst-dispersion spinal fractures treated since the introduction of CT facilities in Western Australia. Twenty-five patients showed spinal canal deformity and stenosis with bone fragments protruding into the canal on the initial scan. Of these, 22 patients were treated nonsurgically. Fifteen of the conservatively treated patients were available for follow-up, and they form the basis of this report. Thirteen of the 15 patients who had repeat CT at follow-up showed correction of the previously measured spinal canal stenosis by spontaneous resorption of intraspinal bone fragments. In view of this previously unreported finding, it is suggested that the role of surgical correction of spinal canal stenosis resulting from displaced bone fragments after trauma be more clearly defined.     

Cerebrospinal fluid flow in the cervical spinal canal in patients with chronic neck pain

Purpose: To measure the cerebrospinal fluid (CSF) velocity in the cervical spinal canal both above and below a stenotic segment in patients with cervical spinal stenosis. The cord velocity was also measured at the level of C2.Material and Methods: Thirteen patients with chronic neck pain were examined with MR imaging. The degree of cervical spinal stenosis was assessed and measured on MR images and CSF velocity in the cervical spinal canal was measured using the phase MR flow quantification method at the level of C2 and below the stenotic segment. The cord motion was measured at the level of C2.Results: The peak velocities of CSF in front of the cord at the level of C2 were, on average, a little higher than behind the cord, but the interindividual variation was high. The caudal or rostral velocities of CSF above and below the stenotic segment could be measured in most cases and they were not dependent on the degree of stenosis when assessed visually. When the stenosis was assessed by relating the cord area to the dural sac area, a statistical correlation between narrow spinal canal and high velocities in the anterior CSF space below the stenotic segment was found.Conclusion: Spinal stenosis does not alter the cord or CSF velocities at the C2 level, but increases the velocity of CSF in the anterior CSF space below the stenotic segment when the stenosis is assessed by cord and dural sac area measurements.     

腰椎管狭窄104例与黄韧带的关系

目的　探讨形成腰椎管狭窄症的原因及与黄韧带的关系。方法　对我院 1990年以来手术的 10 4例腰椎管狭窄症进行分析。结果　腰椎管狭窄可由骨性椎管因素造成 ,也可由非骨性物退变增生导致的椎管内占位所造成。结论　腰椎黄韧带钙化、骨化及肥厚是引起腰椎管狭窄的常见原因 ,特别是骨性椎管已有狭窄或有椎间盘突出等病变存在时更会加重症状     

Quantitative analysis of the cervical spinal canal by computed tomography

Summary Computed tomography measurements of the AP diameter, width, and cross-sectional area of the bony cervical canal were derived from cervical spine examinations of fifty-two normal adults. These quantitative parameters were then used to evaluate 80 patients with various cervical abnormalities to determine the clinical usefulness of the measurements. With the exception of spinal stenosis, quantitative cervical canal analysis was found to be of limited usefulness since normal measurements frequently occurred in the presence of significant cervical pathology.Protions of this material was presented at the Annual Meeting of the Radiological Society of North America Chicago, Illinois, November 14–18, 1983     

腰椎轴向负荷MSCT检查对椎管的影响

目的 评估轴向负荷CT检查对腰椎椎管的影响及其临床意义.资料与方法 45例慢性腰腿痛患者进行了常规CT检查和轴向负荷CT检查.结果 与常规CT检查比较,轴向负荷检查可见硬膜囊横截面积(D-CSA)不同程度的缩小,共有36例109个节段轴向负荷检查D-CSA缩小15 mm2以上.常规CT发现23例(51.1%)共44个节段(19.8%)椎管狭窄.轴向负荷检查发现32例(71.1%)共69个节段(31.1%)椎管狭窄.结论 与常规CT比较,轴向负荷检查可引起D-CSA以及矢状径缩小,能发现常规CT检查所不能发现的椎管狭窄水平.