颈椎后纵韧带骨化合并硬膜囊骨化的CT影像特点及临床意义

目的探讨颈椎后纵韧带骨化合并硬膜囊骨化的CT影像特点及临床意义。方法前路手术治疗21倒颈椎后纵韧带骨化患者,术前均行CT三维重建检查,明确后纵韧带骨化诊断及骨化物类型。术中5例患者被证实合并硬膜囊骨化．其中3例手术切除骨化物时造成硬膜囊缺损而出现脑脊液漏,另2例采用骨化物漂浮法减压。结果4例患者的CT横断面影像具有典型的双影征,矢状面成像表现为分层结构。3例脑脊液漏患者经非手术治疗均得以痊愈。随访1～3年,合并硬膜囊骨化患者的神经功能平均恢复率低于其他患者。结论CT三维影像有助于患者术前硬膜囊骨化的诊断,这对前路手术治疗后纵韧带骨化具有重要意义。     

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.     

后纵韧带钩辅助下颈椎后纵韧带骨化物切除减压术

目的探讨后纵韧带钩辅助下颈椎后纵韧带骨化物前路切除的适应证、方法及其临床效果。方法患者19例,男14例,女5例;年龄51-71岁,平均59岁。术前影像学检查结果示后纵韧带骨化物局限型6例,分节型13例;椎管狭窄率32％-75％,平均54％。术前神经功能JOA评分4-14分,平均9．6分。行颈前路常规手术入路,椎体开槽切骨达椎体后壁,范围超过后纵韧带骨化灶。利用后纵韧带钩插入后纵韧带下,钩起后纵韧带及骨化物,在后纵韧带与硬膜间形成一间隙,直视下用超薄型枪状咬骨钳切除后纵韧带及骨化物,而后植骨固定,恢复颈椎稳定性。结果随访6-36个月,平均16个月。术后JOA评分8～16分,平均12．8分,恢复率42％＇-92％,其中疗效优9例,良7例,可3例,优良率84．2％。4例患者术后并发脑脊液漏,保守治疗后均获得痊愈。术后CT和MR检查显示骨化后纵韧带切除完全,脊髓和硬膜囊形态恢复良好。结论后纵韧带钩可提高颈椎前路手术切除后纵韧带骨化物的安全性和有效性,适用于局限型和分节型、切除范围在两个椎节之间的颈椎后纵韧带骨化症患者。     

颈椎后纵韧带骨化影像学研究进展

颈椎后纵韧带骨化压迫脊髓、神经根,临床上可出现脊髓损害症状及神经根刺激症状。根据矢状位影像将其分为五种类型:连续型、节段型、混合型、局限型及萌芽型。萌芽型是后纵韧带骨化的早期形式。典型的颈椎后纵韧带骨化在MRIT1象上表现为前方椎体骨髓与后方脊髓间低信号或等信号带,在T2象上位于前方椎体骨髓与后方硬膜囊间,在CT上则直接表现为阳性骨化灶。硬膜囊骨化有单层象和双层象两种CT表现,后者更富特异性。颈椎后纵韧带骨化块在椎间孔内有三种形态。骨密度与颈椎后纵韧带骨化间有一定相关性,研究骨密度对理解其起因很有价值。     

2002年(第9卷1—7期)分类索引

骨病1　颈部疾患颈椎单开门两种固定方法的固定效果之生物力学研究 (王向阳 ,等 ) 1 :1 4侧块固定在颈椎伤病中应用 (附 36例临床研究 ) (田纪伟 ,等 ) 2 :1 37颈性眩晕的病因及其治疗 (王　峰 ,等 ) 2 :1 4 9脊髓型颈椎病患者的性功能改变 (附 1 4例分析 ) (秦茂春 ,等 ) 3 :2 2 5先天性椎动脉发育不良所致椎动脉型颈椎病 (任先军 ,等 ) 4 :31 7椎体次全切除植骨融合治疗颈椎后纵韧带骨化症 (杨庆国 ,等 ) 4 :32 0螺旋ＣＴ三维重建在颈椎后纵韧带骨化中的应用 (赖志军 ,等 ) 4 :32 3高龄患者颈椎手术围手术期的呼吸循环改变 (朱秋峰 ,等 ) …     

多节段颈椎后纵韧带骨化症的外科治疗

目的评价单开门颈椎管扩大成形术对多节段颈椎后纵韧带骨化症的治疗效果。方法我院1998年4月-2003年4月采用单开门颈椎管扩大成形术治疗26例多节段颈椎后纵韧带骨化症患者，对其进行临床回顾性分析。结果26例获2-6年(平均3．5年)随访，按JOA疗效评定标准，优14例，良8例，可3例，差1例。平均改善率为70％，影像学显示颈椎管扩大充分，减压彻底，硬脊膜膨隆良好。结论单开门颈椎管扩大成形术是治疗多节段颈椎后纵韧带骨化症的一种有效术式。     

颈椎前路手术中后纵韧带切除的探讨

目的：探讨颈椎前路手术后纵韧带切除的指征、方法和注意事项，方法：对2000年4月－2002年4月后纵韧带切除的50例颈椎前路手术患者的临床资料及手术治疗结果进行回顾性分析。结果：42例获得6个月以上随访，根据JOA评分标准，平均改善率为70．5％，优14例，良16例，中9例，差3例，结论：后纵韧带退变肥厚、后纵韧带骨化或硬膜外型颈椎间盘脱出压迫颈髓时，行颈椎前路手术时应切除后纵韧带，彻底减压。     

颈椎后纵韧带骨化症前路手术的多因素分析

[目的]探讨影响颈椎后纵韧带骨化症前路手术疗效的相关因素。[方法]48例颈椎后纵韧带骨化症患者，行前路手术治疗，随访1～4年，平均2．1年。根据术后神经功能JOA评分改善率，将患者分为预后良好、预后不佳2组。采用多元Logistic回归分析患者年龄、性别、神经功能、症状持续时间、合并糖尿病、Pavlov值、椎管狭窄率、骨化物分型、CT双影征、脊髓高信号、手术范围以及骨化物处理对患者手术疗效的影响。[结果]骨化物的处理方式是影响患者疗效的唯一因素（P=0．0067）。[结论]前路手术彻底切除骨化之后纵韧带，对脊髓充分减压是前路手术治疗颈椎后纵韧带骨化症的关键。     

应用单开门椎板成形术治疗颈椎后纵韧带骨化症

目的 探讨颈椎后纵韧带骨化症的适宜手术入路及方式。方法 观察及分析应用单开门椎板成形术治疗颈椎后纵韧带骨化症３０２例的近期与１－９年远期临床疗效并将手术前、后Ｘ线片、ＣＴ及ＭＲＩ等影像学资料进行对比。结果 ３０２例后纵韧带骨化症手术近期及远期神经功能评分显著提高,平均改善率分别为４６％和６８％,后Ｘ线片显示颈椎管矢以显著增加,ＣＴ示椎管截面积显著扩大,而ＭＲＩ则显示脊髓向后移行,前后方压迫均解除。     

颈椎后纵韧带骨化症伴发育性椎管狭窄的临床特点及治疗

[目的]探讨颈椎后纵韧带骨化症伴发育性椎管狭窄的临床特点及其治疗。[方法]对76例颈椎后纵韧带骨化症患者的临床资料进行回顾性分析。根据原始X线片测量颈椎椎体、椎管矢状径,计算Pavlov比值,根据计算结果将患者分为伴发育性椎管狭窄颈椎后纵韧带骨化症组（DSS组）和不伴发育性椎管狭窄颈椎后纵韧带骨化症组（NDSS组）。根据CT分别测量两组骨化灶最大厚度,计算椎管矢状径残存率。其中前路手术4例,后路手术72例,按JOA标准评分判断术后改善率。[结果]DSS组53例,NDSS组23例;NDSS组骨化灶最大厚度比DSS组大,有统计学意义;发病时两组椎管矢状径残存率有差异,但是无统计学意义;两组术前、术后3个月JOA评分有差别,但是无统计学意义。[结论]发育性椎管狭窄是影响颈椎后纵韧带骨化症病程的重要病理基础,创伤是诱发其发病的主要因素,后路减压术是一种较合理的治疗方式。     

Co-existence of ossification of the nuchal ligament is associated with severity of ossification in the whole spine in patients with cervical ossification of the posterior longitudinal ligament -A multi-center CT study-

Background

Previous studies have shown that patients with cervical ossification of the posterior longitudinal ligament (OPLL) often have co-existing ossification of the nuchal ligament (ONL). However, no studies have focused on ONL and its relevance to the severity of OPLL or ossification of other spinal ligaments, such as anterior longitudinal ligament (OALL), ligamentum flavum (OLF), and supraspinous/interspinous ligament (OSIL).

Clinical and radiological study of ossification of the anterior longitudinal ligament in the cervical spine

Twenty-seven patients with ossification of the anterior longitudinal ligament (OALL) in diffuse idiopathic skeletal hyperostosis (DISH) in the cervical region were diagnosed among 2000 individuals during 10 months and analyzed clinically and radiologically by two neurosurgeons. Sex distribution was 20 men and 7 women with ages ranging from 57 to 82 years (average: 72.3 y.o.). Main signs and symptoms were dysesthesia of the upper extremities, stiff neck, dizziness and dysphagia (33%). Three patients had diabetes mellitus, 14 had hypertension, and 15 had hyperuremia. Ossification of the posterior longitudinal ligament (OPLL) co-existed in 18 patients (66%). Number of vertebral bodies with cervical OALL ranged from 4 to 6 (average: 4.8) and thickness of ossification of the anterior longitudinal ligament was from 2 to 6 (average: 3.1) mm. Originally we divided OALL in the cervical region into 3 types, nodular-type; 16 cases, continuous-type; 7 cases, and mixed-type; 4 cases. Small OPLL can be diagnosed by either cervical CT or myelo-CT. DISH is thought to be a benign clinical entity, but patients with OALL in DISH, accompanied by OPLL and those accompanied by dysphasia are frequently encountered and sometimes may be treated surgically.     

Diagnosis and surgical management of cervical ossification of the posterior longitudinal ligament.

BACKGROUND CONTEXT: The diagnosis and treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL) is continuing to evolve as its effects become more readily recognized and surgical alternatives expand. PURPOSE: To review the clinical, neurodiagnostic and surgical management of OPLL. STUDY DESIGN/SETTING: Patients with early OPLL, often in their mid-forties, present with radiculopathy or mild/moderate myelopathy. Radiographically, hypertrophy of the posterior longitudinal ligament with punctate ossification appears opposite multiple disc spaces. Patients with classic OPLL frequently become symptomatic in their mid-fifties with radiographic characteristics showing ossification of the ligament behind the vertebrae alone (segmental), behind the vertebrae including the intervertebral disc spaces (continuous), and combinations of the segmental and continuous variants and OPLL opposite disc spaces alone. Both magnetic resonance imaging (MRI) and computed tomography (CT) examinations are critical. MRI better delineates the extent of soft tissue abnormalities in three dimensions, including the cervicothoracic junction, whereas CT more readily identifies the foci of frank ossification. Surgical alternatives include anterior, posterior or combined approaches. Anterior surgical options include plated multilevel anterior discectomy and fusion, anterior cervical corpectomy with fusion (ACF), or plated multilevel ACF with differing posterior fusion techniques. Posterior surgical options vary from laminectomy with or without simultaneous fusion and laminoplasty. Although outcomes with different approaches vary, many direct anterior resection techniques achieve more favorable results because of appropriate and adequate resection of the ligament. CONCLUSIONS: The clinical and neuroradiographic documentation of OPLL and its appropriate surgical management anteriorly, posteriorly or circumferentially remain a therapeutic challenge.     

颈椎后纵韧带骨化症的手术治疗

目的探讨颈椎后纵韧带骨化症手术治疗方法及其疗效。方法回顾性分析2002年1月至2008年1月我院65例颈椎后纵韧带骨化症手术治疗病例。均有程度不等的脊髓压迫症状。41例合并发育性颈椎管狭窄,平均椎管狭窄率42．1％。术前均行X线、CT平扫加矢状位重建和MRI检查。其中23例行前路手术,37例行后路手术,5例行前后路联合手术。结果65例获6～72个月随访,平均随访时间19个月。根据日本矫形外科学会评分标准,颈前路手术平均改善率70％,颈后路手术平均改善率66．3％,颈前后路联合手术平均改善率75．4％。术后并发节段性神经根麻痹5例。结论根据患者病情和影像学表现,尤其是CT矢状位重建,仔细分析后纵韧带骨化部位、范围及椎管狭窄率,选择合适手术方法,方能减少并发症,提高手术疗效。     

颈椎后纵韧带骨化症术后骨化进展分析

目的 研究颈椎后纵韧带骨化(ossification of posterior longitudinal ligament,OPLL)症术后骨化进展情况.方法 对2001年1月至2007年12月手术治疗的95例颈椎OPLL患者进行回顾性研究,男72例,女23例;年龄40～73岁,平均56.3岁;随访时间1～6年,平均3.1年.颈椎前路手术36例,颈椎后路全椎板减压固定手术57例,前后路联合手术2例.根据术前、术后随访时的X线、CT及MR影像学资料对骨化进展情况进行测量,并通过统计分析性别、年龄、涉及C3OPLL、伴胸椎OPLL、骨化类型、随访时间、手术方式、日本矫形外科学会评分(Japanese orthopaedic association scores,JOA评分)及改善率与骨化术后进展的关系.结果 95例颈椎OPLL术后随访患者中,术后骨化进展39例,男28例,女11例;手术时年龄41～71岁,平均55.9岁;年龄≤49岁12例,50～59岁12例,60～69岁12例,年龄≥70岁3例.颈椎OPLL后路手术后骨化进展有35例,而前路手术后骨化进展仅4例.以骨化物长度和(或)厚度进展≥2mm为标准,单纯骨化长度进展4例;骨化长度、厚度均进展33例;单纯骨化厚度进展2例.骨化长度进展2～20 mm,平均(7.74±4.71)mm;骨化厚度进展2～6 mm,平均(2.67±1.51)mm.在术后1～3年内骨化进展速度呈下降趋势,4～6年骨化则有部分加速趋势.JOA评分及其改善率在术后3年内达到最佳值.统计结果 显示颈椎OPLL术后骨化进展与患者年龄、手术方式以及涉及C3OPLL明显相关.结论 颈椎OPLL术后骨化进展有相当的发生率,涉及C3OPLL、行颈椎后路全椎板切除手术、年轻的颈椎OPLL患者其骨化进展率相对较高.在中短期(1～6年)随访时间内,JOA评分及其改善率受骨化进展影响不大.     

Ossification of the ligamentum flavum of the cervical spine

AIM: Ossification of ligamentum flavum (OLF) mainly occurs in the thoracic spine, and rarely in the cervical spine. To clarify its etiology; the features of OLF in the cervical spine were reviewed in 50 reported cases. METHODS: Age, sex, location of OLF, classification of OLF, radiographic findings, computed tomography (CT) findings, magnetic resonance imaging findings, association of ossification of the posterior longitudinal ligament (OPLL), association of OLF in other spinal regions, and association of diffuse idiopathic skeletal hyperostosis (DISH) were analyzed in 23 detailed cases. RESULTS: Association of OPLL was observed in 7 of 20 cases and 4 of these 7 OPLL cases were at C2-4. Association of OLF in other spinal regions was recognized in 7 of 15 cases. DISH was also present in 3 of 7 cases. Local kyphosis was recognized in 10 of 12 cases by radiography. CT showed facet hypertrophy in 13 of 15 cases and lamina hypertrophy in 14 of 16 cases. Patients with OLF at C2-4 had high rates of local kyphosis and association of hyperostotic state, suggesting both local factors and systemic hyperostotic factors are involved in the formation of OLF of the upper cervical spine. CONCLUSION: Local factors may be strongly related to the formation of OLF of the middle or lower cervical spine.     

Epidemiological Survey of Ossification of the Posterior Longitudinal Ligament in an Adult Korean Population: Three-dimensional Computed Tomographic Observation of 3,240 Cases

The prevalence rates of ossification of the posterior longitudinal ligament (OPLL) in the Korean population were reported as 3.4 and 0.6 %. However, these studies were performed before the era of three-dimensional computed tomography (3D CT). We investigated the prevalence of cervical OPLL on the basis of 3D CT and features of OPLL distribution in an adult Korean population. During 2011 and 2012, a total of 3,240 patients were enrolled who had undergone thyroid 3D CT. A total of 1,084 men and 2,156 women were included. Axial and sagittal reconstruction images were used for observations. More than 2 mm thickness in an axial image was the criterion for the presence of OPLL. The prevalence rate was adjusted according to a standardized population according to Statistics Korea. The OPLL prevalence rate was 5.7 %. The standardized prevalence rate was 4.60 %. The standardized prevalence rates in men and women were 6.43 and 3.61 %, respectively. The over-70 age group had the highest OPLL prevalence. Age and prevalence rate were positively correlated in men and women (correlation coefficient 0.991 and 0.991, P < 0.001 and P < 0.0001, respectively). Among OPLL types, the multiple segmental type was most frequent (37.3 %). The most commonly involved level was C5 (4.8 % in men, 2.2 % in women), C4 (4.6 % in men, 1.2 % in women), and C6 (3.7 % in men, 2.4 % in women) segments, in decreasing order. To our knowledge, this study is the first 3D CT–based epidemiologic study on cervical OPLL in a Korean population.     

Identification of ossification of the posterior longitudinal ligament extending through the dura on preoperative computed tomographic examinations of the cervical spine

STUDY DESIGN: To establish the diagnosis of dural penetration on preoperative computed tomographic studies of the cervical spine in patients with ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: To define before surgery the pathognomonic computed tomographic findings of OPLL extending to and through the dura. SUMMARY OF BACKGROUND DATA: On preoperative computed tomographic studies, Hida et al have described the single-layer sign characterized by a solid mass of hyperdense OPLL and the double-layer sign defined by two (anterior and posterior) ossified rims surrounding a central nonossified but hypertrophied posterior longitudinal ligament. Only 1 of the 9 patients exhibiting the single-layer sign but 10 of 12 patients showing the double-layer sign had no separate dural plane identified at surgery. METHODS: Only 2 of 54 patients undergoing multilevel cervical circumferential OPLL procedures had absent dura at surgery. Computed tomographic examinations for all patients were retrospectively reviewed to determine unique signs of dural penetration. RESULTS: Dura was absent in 1 of 12 patients who had the single-layer CT sign that was additionally characterized by an irregular C angular configuration. Only 1 of 4 patients exhibiting the double-layer computed tomographic sign had absent dura at surgery. The remaining 38 patients had the smooth-layer sign, characterized by more regular margins of classic (22 patients) or early OPLL (16 patients). CONCLUSIONS: The double-layer computed tomographic sign is more pathognomonic for dural penetration than the single-layer sign. The smooth-layer sign, indicating a clean dural plane, is more typical in North American patients.