An epidemiological survey on ossification of ligaments in the cervical and thoracic spine in individuals over 50 years of age

An epidemiological survey on ossification of the spinal ligaments was performed on a total of 1,058 subjects over the age of 50 years by means of roentgenography of the cervical and thoracic spine. Ossification of the posterior longitudinal ligament (OPLL) of the cervical spine was detected in 34 subjects (3.2%) with a predilection for men, whereas OPLL in the thoracic spine was found in 8 (0.8%). There were 325 cases (30.7%) of ossification of the anterior longitudinal ligament (OALL) of stage II or above by Forestier's classification in the region from the cervical to thoracic vertebrae, and these cases included a significantly greater number of men. Ossification of the ligamenta flava (OLF) was observed in 48 cases (4.5%). As for the coexistence of ossification of these ligaments, 364 individuals (34.4%) had at least one instance of OPLL and OALL (stage II or above) in the region from the cervical to thoracic spine, and OLF in the thoracic spine.     

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).

Ossification of the spinal ligament. A radiographic reevaluation in Bologna, Italy

A radiographic reevaluation of cervical spine films of 1,258 adult patients and of thoraco-lumbar spine films of 488 of these was performed at the Rizzoli Orthopaedic Institute (Bologne, Italy), in order to detect ossification of the posterior longitudinal ligament (OPLL), the anterior longitudinal ligament (OALL), the yellow ligament (OYL) and the nuchal ligament at the cervical level, and OPLL, OALL and OYL at the thoraco-lumbar level. The incidence of OALL, OYL and ossification of the nuchal ligament corresponded with those previously reported in the literature. Cervical OPLL was found in 1.83%, with a definite prevalence in the 45-64 age group where the figure was 2.83%. This incidence is much higher than that hitherto reported in Caucasians, and is nearly the same as that in Japan. Possible explanations for this discrepancy are proposed.     

Cervical spinal cord injury caused by vertebral body fracture in a patient with concomitant OALL and OPLL

We encountered a case of cervical spinal cord injury associated with cervical vertebral dislocation fracture that occurred in a patient with concomitant ossification of the anterior and posterior longitudinal ligaments. The cervical vertebrae were injured by hyperextension in a car accident. On admission, shearing fracture was noted in the OALL region and vertebral body OPLL region over the posterior column at the fourth cervical level, but no dislocation or neurological findings were noted. Restlessness occurred and caused dislocation several hours after admission, leading to complete injury of the cervical spinal cord. The patient died of complications after 3 weeks. Vertebral body fracture complicated by both OALL and OPLL is very rare, and only four cases have been reported. Since vertebral injury causes delayed fracture/dislocation after a symptom-free interval in cases with ligament ossification, accurate clinical evaluation early after injury and early fixation are necessary.     

Symptomatic ossification of the anterior longitudinal ligament with stenosis of the cervical spine: a report of seven cases

Seven men with a mean age of 63.9 years (59 to 67) developed dysphagia because of oesophageal compression with ossification of the anterior longitudinal ligament (OALL) and radiculomyelopathy due to associated stenosis of the cervical spine. The diagnosis of OALL was made by plain lateral radiography and classified into three types; segmental, continuous and mixed. Five patients had associated OALL in the thoracic and lumbar spine without ossification of the ligamentum flavum. All underwent removal of the OALL and six had simultaneous decompression by removal of ossification of the posterior longitudinal ligament or a bony spur. All had improvement of their dysphagia. Because symptomatic OALL may be associated with spinal stenosis, precise neurological examination is critical. A simultaneous microsurgical operation for patients with OALL and spinal stenosis gives good results without serious complications.     

颈椎病合并颈椎后纵韧带骨化症的前路手术治疗

目的 探讨颈椎病合并颈椎后纵韧带骨化症(OPLL)前路切除减压的方法及其临床效果.方法采用颈椎前路减压治疗颈椎病合并颈椎OPLL患者61例,其中男42例,女19例,平均57岁(45～74岁).术前明确诊断颈椎病合并OPLL者49例,术中发现合并有OPLL者12例.OPLL椎管狭窄率32%～70%,平均52%.神经功能JOA评分术前4～14分,平均9.6分.手术在常规颈前路经椎间隙或椎体次全切除减压的基础上,切除骨化后纵韧带彻底减压.结果 本组41例患者采用前路椎体次全切除减压,6例经椎间隙扩大减压,14例采用椎体次全切除结合经椎间隙减压的手术方式.所有患者随访6个月～3年,平均16个月.术后JOA评分8～16分,平均12.8分,神经功能恢复率25.0%～87.5%,平均65.2%.5例患者术后并发脑脊液漏,经保守治疗后均获得痊愈,无1例出现脊髓功能损害加重.结论 颈椎病合并颈椎OPLL增加了手术难度和风险,在颈椎前路常规减压的基础上再将骨化的后纵韧带切除,保证了前路减压的彻底性,可提高手术治疗效果.     

前路飘浮法治疗颈椎后纵韧带骨化症初步报告

目的 :对前路飘浮法治疗颈椎后纵韧带骨化症 (OPLL)手术疗效进行初步评析。方法 :对 16例颈椎O PLL患者行前路飘浮法治疗 ,其中连续型 3例 ,节段型 8例 ,混合型 3例 ,孤立型 2例 ;最长手术节段 3节 ;椎管狭窄率 3 0 %～ 70 %。所有患者均采用钛板、钛网行颈椎重建。术后对近期结果随访 ,并按日本矫形外科协会 (JOA)评分系统评分。结果 :平均随访时间 6个月 ,平均恢复率为 68 2 %。无脑脊液漏、神经损伤等并发症发生。颈椎融合良好。结论 :前路飘浮法适合于大多数OPLL患者 ;新型颈椎内固定系统扩大了前路OPLL手术适应证     

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。     

Traumatic fracture-dislocation of C5 on C6 through a previously solid multilevel anterior cervical discectomy and fusion: a case report and review of the literature.

BACKGROUND CONTEXT: Due to the underlying pathology and altered biomechanics, traumatic cervical fractures have been reported in patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), ossification of the posterior longitudinal ligament (OPLL), and combination of DISH and OPLL. However, incidence of a fracture-dislocation through a solid multilevel anterior cervical discectomy and fusion (ACDF) construct with no associated underlying pathology of AS, DISH, or OPLL but severe osteopenia has not, to the best knowledge of the authors, been reported in the medical literature. PURPOSE: To report the development of an unstable cervical spine fracture that occurred through a previous multilevel anterior cervical fusion and the challenges associated with the diagnosis and surgical management of these uncommon lesions. STUDY DESIGN/SETTING: A case report and review of the literature. METHODS: A case report entailing the clinical history, operative management, and postoperative course of a 72-year-old male patient with no known AS, DISH, or OPLL who suffered a cervical spine fracture-dislocation, secondary to a motor vehicle accident, through a previous solid three-level ACDF that was performed 20 years earlier. RESULTS: The patient underwent emergent reduction and realignment of the cervical fracture-dislocation, eventual posterior spinal fusion and stabilization with rigid segmental internal fixation, and application of external halo immobilization. At recent follow-up, he has radiographic evidence of fusion and maintenance of sagittal alignment without loss of reduction. CONCLUSIONS: Multilevel cervical fusion constructs are susceptible to traumatic injuries. Many of the same challenges in the management of the previously fused ACDF patient, who sustains a fracture-dislocation, are similar to those found in the patient with mass-inflammatory conditions or metabolic disorders, such as AS, DISH, or OPLL. In many cases, this includes severe osteopenia, long unstable fusion segments, and difficulties associated with prolonged halo vest immobilization. As a result, preoperative surgical planning should take into consideration the difficulties in achieving fracture reduction, decompression, and proper stabilization.     

颈椎后纵韧带切除术的方法改进及其临床意义

目的 探讨颈前路经后纵韧带外缘与椎体后缘附着处(解剖切入点)进入椎管,再行后纵韧带切除新方法的可行性、安全性及治疗游离犁颈椎间盘脱出症、脊髓型颈椎病、后纵韧带骨化症的疗效.方法 自2003年11至2007年9月,采用改进的颈前路后纵韧带切除新方法36例,其中游离型颈椎间盘脱出症19例、脊髓型颈椎病12例、后纵韧带骨化症5例.对其术后疗效、X-线射片及MRI检查进行分析评定.结果 根据JOA评分:手术前平均10.7分,随访8月至52月,增加到16.2分.平均增加5.4分.结论 经颈前路后纵韧带切除、减压加融合固定治疗游离型颈椎间盘脱出症、后纵韧带肥厚型颈椎病及后纵韧带骨化症具有良好的手术疗效,而采用解剖切入点的后纵韧带切除方法,其操作较简单、安全.     

螺旋CT三维重建在颈椎后纵韧带骨化中的应用

目的：探讨螺旋CT三维重建显示颈椎后纵韧带骨化的价值和临床意义。方法：回顾性分析21例颈椎后纵韧带骨化的螺旋CT扫描资料。结果：颈椎后纵韧带骨化按Hirabayashi分型，节段型3例，连续型9例，混合型5例，其它型4例。结论：螺旋CT三维重建能清晰显示颈椎后纵韧带骨化的范围，厚度，形状。三维重建有助于手术入路设计，有助于理解骨化的复杂性。螺旋CT是颈椎后纵韧带骨化最好的检查方法，应该常规使用。     

Prevalence and progression of radiographic ossification of the posterior longitudinal ligament and associated factors in the Japanese population: a 3-year follow-up of the ROAD study

Summary

The prevalence of radiographic cervical ossification of the posterior longitudinal ligament (OPLL) in 1,562 Japanese from a population-based cohort was 1.9 %. The presence of OPLL showed a significant association with the femoral neck bone mineral density (BMD), presence of diffuse idiopathic skeletal hyperostosis (DISH) and plasma pentosidine levels. Only one new case of radiographic OPLL was detected, but OPLL progressed in all affected subjects.

Introduction

The purpose of this study was to clarify the prevalence and progression of radiographic OPLL and the associated factors, using the population-based cohort Research on Osteoarthritis/osteoporosis Against Disability (ROAD).

Methods

In the ROAD study, 1,690 participants underwent X-ray examination of the entire spine and both knees. Radiographic OPLL, lumbar spondylosis, knee osteoarthritis and DISH were diagnosed by a single, well-experienced orthopaedic surgeon. An interviewer-administered questionnaire and tests for anthropometric measurements were administered, and the BMDs of the lumbar spine and proximal femur were determined. A new OPLL case was considered if heterotopic ossification in the posterior longitudinal ligament was absent at baseline but present during follow-up. Progression was defined as an increase in the maximum length or width of the ossification at follow-up over that at baseline.

Results

Radiographic OPLL was detected in 30 (17 men, 13 women) of 1,562 individuals who underwent X-ray examination of the cervical spine (prevalence?=?1.9 %). Its prevalence was significantly higher in men than in women (p?=?0.007), but no association with age was observed. In a logistic regression analysis, OPLL showed a significant association with the femoral neck BMD, presence of DISH and plasma pentosidine levels. Only one new case of radiographic OPLL was detected, but OPLL progressed in all affected subjects.

Conclusion

This population-based study clarified the prevalence of radiographic OPLL in the Japanese population as well as its progression. OPLL showed significant association with plasma pentosidine levels, BMD and DISH.     

Long-term follow-up results of anterior interbody fusion applied for cervical myelopathy due to ossification of the posterior longitudinal ligament

STUDY DESIGN: A long-term follow-up study was carried out in 30 patients who underwent anterior interbody fusion for cervical myelopathy associated with ossification of the posterior longitudinal ligament (OPLL). OBJECTIVE: To investigate whether anterior interbody fusion without decompression is an appropriate surgical method for long-term relief of cervical OPLL myelopathy. SUMMARY OF BACKGROUND DATA: Several studies of operative results after posterior decompression for cervical myelopathy due to ossification of the posterior longitudinal ligament have been reported. There has been no report about anterior interbody fusion without decompression. The postoperative results of this treatment method applied in cervical OPLL myelopathy have been evaluated by the authors of the present study for more than 10 years. No reports on such a long-term follow-up study have been published in the literature. METHODS: Thirty patients who underwent anterior interbody fusion for cervical OPLL myelopathy were evaluated clinically and radiographically. The mean follow-up period was 14.7 years (range, 10-23 years). RESULTS: Clinical results were evaluated according to Okamoto's classification. At the time of the final follow-up evaluation, 16 patients had improved in functional score by two grades, and their surgical results were regarded as excellent; eight patients improved by one grade, and their clinical outcomes were regarded as good; five patients showed no change; and the condition of one patient deteriorated. As for radiographic analysis, the type of ossification had changed in four cases. Ossification width and thickness increased in 26 patients. Postoperative alignment of the cervical spine showed kyphosis in three patients, straight spine in 11 patients, and lordosis in 16 patients. CONCLUSION: Anterior interbody fusion without decompression is an effective treatment for cervical OPLL myelopathy that resulted in stable long-lasting conditions.     

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.     

胸椎黄韧带骨化症合并脊髓型颈椎病的临床诊断要点

目的总结胸椎黄韧带骨化症合并脊髓型颈椎病的临床特点,探讨避免漏诊胸椎黄韧带骨化症的方法。方法对比分析胸椎黄韧带骨化症合并脊髓型颈椎病和单纯脊髓型颈椎病的临床表现、影像学表现、JOA评分的异同。结果共收集35例胸椎黄韧带骨化症合并脊髓型颈椎病病例,其中20例合并连续型颈椎后纵韧带骨化和/或弥漫性特发性骨肥厚症,14例是因颈椎MRI发现上胸椎黄韧带骨化后进一步行全胸椎MRI检查后确诊;胸椎黄韧带骨化症合并脊髓型颈椎病者的上肢功能评分构成比较单纯脊髓型颈椎病者为高(p<0.05)。结论胸椎黄韧带骨化症合并脊髓型颈椎病的诊断须综合分析病史、体征和影像学表现;JOA脊髓功能评分可以为其确诊提供帮助。     

Aortic pulsation prevents the development of ossification of anterior longitudinal ligament toward the aorta in patients with diffuse idiopathic skeletal hyperostosis (DISH) in Japanese: Results of chest CT-based cross-sectional study

Background

The development and etiology of diffuse idiopathic skeletal hyperostosis (DISH) were far from complete understanding. Even the precise mechanism of the development of its typical right-sided ossification of the anterior longitudinal ligament (OALL) frequently compared to ‘flowing candle wax’, a hallmark of DISH, remains unknown.

多节段脊髓型颈椎病合并后纵韧带骨化症患者的手术方式探讨

目的探讨多节段脊髓型颈椎病合并局灶型后纵韧带骨化症患者手术入路的选择、不同手术方式及结果。方法本组56例多节段脊髓型颈椎病合并局灶型后纵韧带骨化症患者,18例施行前路椎体及病灶切除减压 髂骨或钛网植骨钢板内固定术。30例行后路全椎板减压 Axis侧块钢板固定 关节突植骨。前后路联合手术8例．3例后路术后一期联合前路手术,5例为后路术后症状改善不明显或症状有加重,二期行前路手术。所有病例随访2年以上,采用JOA评分,观察前路、后路和前后路联合3种手术入路的减压效果。结果随访56例,颈前路患者的手术改善率69．69%;颈后路患者的手术改善率65．04%;前后路联合患者的手术改善率75．25%。3种术式存在显著差别。并发症发生率以颈后路手术者最低。结论多节段脊髓型颈椎病合并局灶型后纵韧带骨化症患者手术效果虽然以前后路联合手术为最好,但并发症发生率也最高,而颈后路手术并发症发生率最低。因此应根据患者体质、病情以及影像学表现仔细分析。选择相应的手术方式。     

严重颈椎后纵韧带骨化症前路和后路手术比较

目的 探讨前路和后路手术治疗严重颈椎后纵韧带骨化症的适应证选择、疗效及并发症.方法 2004年1月至2006年12月,手术治疗椎管狭窄率大于50%的严重颈椎后纵韧带骨化症患者34例(男29例,女5例,平均57.2岁),前路采用椎体次全切除减压钛网植骨内固定术14例(男12例,女2例),后路采用椎板切除减压侧块螺钉固定术20例(男17例,女3例).比较两种手术方式患者的颈椎管矢状径、颈椎曲度、椎管狭窄率、骨化物分型、骨化物范围、脊髓压迫率等的差异.采用JOA评分评价患者术前、术后神经功能,并计算改善率.结果 影像学结果显示前路手术主要为范围在3个节段以内的局限型和分节型骨化患者,而后路手术主要为范围超过3节段的连续型和混合型骨化患者,骨化物的分型及范围是选择的主要依据.所有患者随访6个月～3年,平均1.5年.前路手术组JOA评分从术前平均(9.3+1.8)分提高至术后平均(14.2±1.3)分,平均改善率62.3%±15.2%;后路手术组JOA评分从术前平均(8.7+1.6)分提高至术后平均(11.4±1.2)分,平均改善率33.5%±12.7%.两组患者疗效差异有统计学意义(P＜0.01).结论 对于骨化范围在3个节段以内的患者,前路手术是安全、有效的治疗方式,而后路手术则适用于范围超过3个节段的严重颈椎后纵韧带骨化症患者.     

Coexistence of flavum ligament ossification with diffuse idiopathic skeletal hyperostosis in the cervical spine: Review of literature and technical note starting from a rare case

BackgroundCervical flavum ligament ossification (C-OLF) is very rare source of myeloradiculopathy. Less than 100 cases have been reported in modern English literature up to 2020. Association between C-OLF and Diffuse Idiopathic Skeletal Hyperostosis (DISH) at cervical level has never been described.MethodsIn this article we performed a systematic review about epidemiology, physiopathology, clinical and surgical management of C-OLF. Moreover, we research its possible association with other cervical spine ligament ossification and in particular with anterior longitudinal ligament ossification. We report a case of 73 years-old woman experiencing mild cervical myeloradiculopathy caused by C6-C7 C-OLF compression and coexistence of DISH at cervico-thoracic level. A brief technical note about intraoperative management of C-OLF has also been described.ResultOur research found 81 previous reported case of C-OLF. The coexistence of Posterior longitudinal ligament ossification has been reported in 21.3% of C-OLF case. Conversely, we reported the first case describing the association between DISH and C-OLF. Posterior surgical decompression is the only useful treatment providing good long-term functional outcome. Instrumentation should be tailored according to pre-operative findings.ConclusionsC-OLF is a rare source of myeloradiculopathy and it may coexists with DISH probably due to alteration in the cervical mechanical stress and tendency of bone formation in patients harboring coexistent ligament ossifications. According to our result, skip en-bloc microsurgical laminectomy is safe and less invasive method to avoid complication and to provide optimal cervical spinal cord and nerve decompression avoiding CSF-leak.     

分期后路-前路联合手术治疗颈椎后纵韧带骨化症伴重度脊髓型颈椎病的疗效分析

目的:探讨分期后路-前路联合手术治疗颈椎后纵韧带骨化症(ossification of the posteriorl ongitudinal ligament,OPLL)伴重度脊髓型颈椎病患者的疗效。方法:2005年1月至2008年6月共收治颈椎OPLL伴重度脊髓型颈椎病患者35例,均先行后路椎板切除减压植骨内固定术,术后3～6个月,行影像学检查均发现颈髓前方尚有压迫和/或神经根麻痹,再行前路椎体次全切除及骨化物切除减压植骨内固定术。术前及第一、第二次术后(末次随访时)行JOA(17分法)评分,分析比较术前、术后评分并计算改善率。结果:一期后路手术后3例患者出现C5神经根麻痹症状,经保守治疗后1例症状消失,2例有所减轻,二期前路手术后症状消失。2例患者前路术后出现脑脊液漏,经适当加压等保守治疗后愈合。本组平均随访时间21.5±5.0个月,术前JOA评分6.9±2.3分,第一次后路手术后JOA评分11.2±4.2分,改善率为(43±22)%;二期前路手术后JOA评分14.0±3.8分,改善率为(48±20)%,与未治疗之前相比改善率为(70±21)%。第一次后路手术后改善率≤35%的患者(17例),二期前路手术后均取得较好的改善率,54%～68%,平均(60±16)%。结论:对于颈椎OPLL伴重度脊髓型颈椎病患者,后路手术后3～6个月,若前方尚有压迫和/或神经根麻痹者,尤其是后路手术改善率≤35%的患者,二期前路手术可进一步提高手术改善率,达到良好的神经功能恢复效果。