过伸性颈椎颈髓损伤的诊断和治疗

报道４３例过伸性颈椎颈髓伤。所有病例均进行了ＭＲＩ检查，结果示颈椎损伤的ＭＲＩ改变主要为：（１）椎前血肿形成和前纵韧带断裂；（２）椎体前缘撕脱性骨折；（３）椎间盘突出。颈髓损伤的ＭＲＩ改变包括：（１）水肿；（２）出血；（３）受压。大多数病（３４／４３）采用颈前路减压术。经６～６５个月，平均３８个月随访，获得满意疗效。作者指出，急性颈椎间盘突出是过伸性颈椎损伤后多见的颈椎结构损伤，除了脊髓中央综合征外，前脊髓损伤和严重脊髓损伤也可见于过伸性颈髓损伤。ＭＲＩ对过伸性颈髓损伤的诊断和治疗方法选择具有重要价值。文中根据临床表现和ＭＲＩ检查结果，提出了在治疗方法选择方面应掌握的基本原则。     

脊柱骨转移瘤MRI诊断价值

作者报告５５例脊椎转移瘤ＭＲＩ表现，并与Ｘ线平片、平扫及增强ＣＴ、椎管造影、椎管造影ＣＴ（ＣＴＭ）等方法相比较，在显示肿瘤的解剖关系，包括骨破坏、椎管内侵犯、椎旁软组织延伸、病理压缩性骨折等方面，ＭＲＩ明显优于Ｘ线平片，平扫及增强ＣＴ，至少等于脊髓造影和ＣＴＭ，但是ＭＲＩ诊断脊椎转移瘤，大多数病例不需要椎管内注射造影剂。ＭＲＩ作为一种新的可供选择的技术，对脊椎转移瘤的诊断有重要价值。在大多数病例中可以替代脊髓造影和ＣＴＭ     

全脊髓造影的方法及其在脊柱外科的应用

全脊髓造影的方法及其在脊柱外科的应用方国华曾兵章恕作者单位：３１２０００浙江绍兴市人民医院骨科（方国华，章恕）；绍兴市第四人民医院骨科（曾兵）全脊髓造影即蛛网膜下腔注入造影剂后一次完成腰段，胸段和颈段的造影。在ＣＴ和ＭＲＩ普遍应用的今天，全脊髓造影的...     

MRI在颈椎病术前检查中的意义（附32例报告）

术前要对颈椎病的诊断、病史部位及严重程度等有明确的了解，普通Ｘ线片、脊髓造影、ＣＴ等检查部难以全部达到这些要求，本文通过对３２例颈椎病病人术前ＭＲＩ检查，认为ＭＲＩ可清楚地显示颈椎全貌，对病变部位、程度、范围等均能明确显示，可以排除肿瘤及脊髓病变，对指导手术有重要意义。     

过伸性颈椎颈髓损伤的诊断与治疗

报道４３例过伸性颈椎颈髓伤。所有病例进行了ＭＲＩ检查，结果示颈椎损伤的ＭＲＩ改变主要为：（１）椎前血肿形成和前纵韧带断裂；（２）椎体前缘撕脱性骨折；（３）椎间盘突出。颈髓损伤的ＭＲＩ包括：９１）水肿；（２）出血；（３）受压，多数闰同采用颈前咱砬压术，经６－６５个月，平均３８个月随访，获得满意疗效。     

脊髓型颈椎病手术前后MRI改变及其临床意义

目的：探讨脊髓型颈椎病手术前后的ＭＲＩ改变与临床意义。方法：１８例脊髓型颈椎病患者于手术前后均行ＭＲＩ检查。观察脊髓的形态学及信号改变与临床疗效之间的关系。结果：术前ＭＲＩ主要特点是受累节段椎间隙变窄，椎体后缘骨赘形成，椎间盘变性，Ｔ１加权呈低信号，颈髓受压移位、形态改变；Ｔ２加权信号异常变化。术后ＭＲＩ主要表现是植骨块稳定，颈髓矢状径及形态有不同程度恢复。结论：手术前后的ＭＲＩ改变可直接反映颈髓的病变程度及预后。ＭＲＩ作为对颈髓病变的诊断、治疗及预后判断具有重要临床意义     

颈椎间盘突出症的MRI表现及意义

探讨了１１８例颈椎间盘突出症的ＭＲＩ表现及异临床意义。在ＭＲＩ上，本病可分为中央型和侧方型。前者颈椎间盘从其后方中央部位突出，压迫颈髓前方，受压颈椎弯曲、变扁及向后移位；后者可见椎间盘从后外侧呈块状或碎片状突出，压迫颈髓前外侧，神经根向后外侧移位或消失。本组结果表明，ＭＲＩ可直接显示颈椎间盘突出症的部位、类型及颈髓和神经根的受损程度，为颈椎盘间突出症的诊断、鉴别诊断、治疗方法选择和预后判断提供可靠的方法。     

无症状或正常颈椎MRI影像表现特征及临床意义

目的：观测无症状或正常人颈椎ＭＲＩ表现，分析与讨论其影像学某些异常表现的临床意义。材料与方法：随机选择临床无颈椎病症状与体征者和正常人５８例，施行颈椎磁共振检查，并分析ＭＲＩ表现。结果：无症状者颈椎ＭＲＩ可表现出椎体及其附件结构信号异常（包括椎间盘突出、椎间盘高度丧失及硬膜囊脊髓受压），其异常出现频率与范围随年龄增大而显著增加；其中椎间盘变性及突出较常见，分别为４１例（７０６８％）５７个节段、２３例（３９６５％）３４个节段；椎体骨赘形成２７（４６５５％）例；硬膜囊受压者３４例；４例硬膜囊及脊髓受压但脊髓信号未见明显异常；各节段椎间盘以Ｃ４－５、Ｃ５－６最易发生变性突出，分别为２１例、１６例及１１例及１３例。结论：无症状者或正常人中可发生椎间盘和椎体退变呈类似于颈椎病的影像学某些表现，表明磁共振异常表现可提示颈椎的退变病理过程     

颈部脊髓损伤的若干问题探讨

１９８７年１０月～１９９５年９月，我科收治颈部脊髓损伤患者２１例。临床资料２１例中男１９例，女２例；年龄２７～６１岁；颈部直接受伤者９例，由头部伤致颈部脊髓伤者１２例；影像学检查：摄颈椎Ｘ线平片２０例，颈椎ＣＴ检查者１４例，颈椎ＭＲＩ检查者５例；颈牵引治疗１４例，手术治疗者７例；死亡２例，１例死于肺炎，另１例死于以ＡＲＤＳ为主的ＭＯＦ综合征。讨论１．头伤和颈伤致颈脊髓损伤的关系。２１例颈部脊髓损伤中，颈部直接受伤者仅有９例，而由头部伤引起颈部脊髓损伤者达１２例，其中，无１例重度颅脑损伤，能构成脑…     

颈脊髓压迫症脊髓受压程度与术后效果的关系

目的　探讨在相同手术技术条件下脊髓受压程度与术后效果的关系。　方法　１１４ 例因颈椎疾患入院手术患者,分别为后纵韧带骨化组（ＯＰＬＬ）４１ 例、颈椎病组３２ 例、颈椎间盘突出组４１例。用计算机测量脊髓造影ＣＴ（ＣＴＭ）片中脊髓受压最重部位的脊髓面积和受压比率,根据日本ＪＯＡ评分记录术前、术后评分,分析脊髓形态改变与术后效果的相关性。　结果　三组患者脊髓受压比率、脊髓面积均与病程长短无关;ＯＰＬＬ、颈椎病组患者的术前脊髓面积大小与术后恢复率呈正相关（相关系数分别为０－７４８６ 和０－７４９２）;颈椎间盘突出症组与临床资料无相关。　结论　在相同手术技术条件下,ＯＰＬＬ、颈椎病患者术前脊髓面积大小与术后恢复关系密切;而颈椎间盘突出症患者术前脊髓形态变化不能作为判断术后的恢复指标     

Spinal canal size in ossification of the posterior longitudinal ligament of the cervical spine

BACKGROUND: The size of the spinal canal is a factor that contributes to the neurologic deficits associated with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS: Bone-window computed tomography (CT) examinations of the cervical spine in 64 patients with cervical OPLL were reviewed. Forty-two patients underwent surgical treatment (anterior decompression: 16 patients, posterior decompression: 26 patients). The remaining 22 patients were managed conservatively. Selection of the surgical approach, anterior or posterior, was based on the longitudinal extent of cord compression. RESULTS: The mean developmental size of the spinal canal in the posterior decompression group (10.7 mm at C4) was significantly smaller than the other 2 groups. The spinal canal was narrowed by OPLL to 2.9 to 10.0 mm. The proportion of the patients showing motor deficits of the lower extremities significantly increased when the sagittal canal diameter was narrowed to less than 8 mm. CONCLUSIONS: This study demonstrates critical values of CT-determined spinal canal stenosis. Developmental size of the spinal canal and the residual anterior-posterior canal diameters resulting from OPLL spinal cord compression are important factors influencing clinical management and the neurologic state.     

Ossification of the posterior longitudinal spinal ligament--comparative studies with computerized tomography (author's transl)]

Ossification of the posterior longitudinal spinal ligament (OPLL) was characterized by calcified longitudinal band along the posterior margin of vertebrae, but it has not been possible to know how the cord is compressed within the narrowed spinal canal. Our neuroradiological studies based on CT-view of the 15 cases of OPLL suffering from various degree of myelopathy revealed: 1) Computed tomography precisely delineated shape of OPLL, which was quite polymorphic, like mushroom, irregular cubic and round. OPLL ranged more than two vertebrae was not uniform, but exhibited different configuration at each level. 2) OPLL at lower cervical and higher thoracic regions was difficult to diagnose by conventional lateral roentgenograms, but CT-scan demonstrated clearly whole extent of OPLL. 3) obliteration ratio of the affected spinal canal was calculated on CT-scan. Cases showing severe myelopathy, such as quadriparesis and neurogenic bladder, presented spinal canal stenosis of more than 30%. Spondylosis were concomittant roentgenographic findings on 13 cases of OPLL (87%). However, spondylotic changes responsible to the myelopathy were seen on only three cases. In these case, the obliteration ratio by ossificated ligament was lower than 26%. On conclusion, computed tomographic views of OPLL gave us more detailed information about the stenotic spinal canal and found to be essential examination when considering operative intervention.     

Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia

Ossification of the posterior longitudinal ligament (OPLL) is a common spinal disorder that presents with or without cervical myelopathy. Furthermore, there is evidence suggesting that OPLL often coexists with cervical disc hernia (CDH), and that the latter is the more important compression factor. To raise the awareness of CDH in OPLL for spinal surgeons, we performed a retrospective study on 142 patients with radiologically proven OPLL who had received surgery between January 2004 and January 2008 in our hospital. Plain radiograph, three-dimensional computed tomography construction (3D CT), and magnetic resonance imaging (MRI) of the cervical spine were all performed. Twenty-six patients with obvious CDH (15 of segmental-type, nine of mixed-type, two of continuous-type) were selected via clinical and radiographic features, and intraoperative findings. By MRI, the most commonly involved level was C5/6, followed by C3/4, C4/5, and C6/7. The areas of greatest spinal cord compression were at the disc levels because of herniated cervical discs. Eight patients were decompressed via anterior cervical discectomy and fusion (ACDF), 13 patients via anterior cervical corpectomy and fusion (ACCF), and five patients via ACDF combined with posterior laminectomy and fusion. The outcomes were all favorable. In conclusion, surgeons should consider the potential for CDH when performing spinal cord decompression and deciding the surgical approach in patients presenting with OPLL.     

胸椎后纵韧带骨化的临床特点及治疗策略

目的回顾研究手术治疗胸椎后纵韧带骨化症(OPLL)的临床特点及治疗方法。方法1991至2005年手术治疗胸椎OPLL55例,男19例,女36例;年龄35～73岁,平均51.9岁。均伴有脊髓损害。手术方式包括单纯椎管后壁切除术34例、前方OPLL切除减压术15例以及前后路联合手术6例。结果55例中36例(65.5%)合并胸椎黄韧带骨化(OLF),18例(32.7%)合并颈椎OPLL。单纯发生于上胸椎的OPLL13例(23.6%),中胸椎12例(21.8%),下胸椎及胸腰段17例(30.9%),广泛分布者13例(23.6%)。43例获得随访,平均随访时间47.1个月(6～168个月)。37例神经功能有改善,改善率为76.6%,无改善2例,加重4例。前方入路获随访者13例,其中3例症状加重,余改善率平均为82.9%(42.9%～100%)。后路椎管后壁切除术获随访者25例,1例无改善,1例加重,余改善率平均为72.6%(22.2%～100%)。前后路联合手术获随访5例,1例无改善,余改善率平均为83.9%。结论胸椎OPLL常合并胸椎OLF及颈椎OPLL。上胸椎OPLL合并颈椎管狭窄可一期行颈后路单开门及上胸椎椎管后壁切除术。两个节段以内的OPLL且不合并有造成脊髓压迫的胸椎OLF可行前路OPLL切除减压术,否则行后路椎管后壁切除术。单节段的OPLL合并胸椎OLF可行前后路联合手术。     

伴颈椎后纵韧带骨化的颈脊髓损伤临床特点与疗效

目的探讨颈椎后纵韧带骨化（OPLL）患者外伤时脊髓损伤的临床特点及疗效。方法回顾性分析19例脊髓损伤患者OPLL骨化类型与颈髓NRIT2高信号变化范围、手术方式与手术前后脊髓功能变化的关系。结果伴OPLL的颈椎在较轻的外力作用下常可出现较严重脊髓损伤。伤后8h内行甲泼尼龙冲击治疗12例患者,2例死于并发症,10例患者脊髓功能明显改善。手术治疗17例,1例手术后27d死亡,16例患者术后半年颈髓功能Frankel评分改善。结论OPLL患者外伤后脊髓损伤的程度往往较重,骨化类型与NRI颈髓信号改变平面直接相关。甲泼尼龙冲击治疗、手术减压均有助于颈髓功能的恢复。     

Factors related to the development of myelopathy in patients with cervical ossification of the posterior longitudinal ligament

This study evaluates factors related to myelopathic symptoms in patients with ossification of the posterior longitudinal ligament (OPLL). A total of 87 patients with OPLL were included. Of these, 53 (Group I) had no symptoms or presented with neck pain and radiculopathy and 34 (Group II) had myelopathic symptoms. Gender, age, and history of trauma were evaluated in the two groups. The range of movement of the cervical spine was measured using plain radiographs. The number of involved segments, type of OPLL, and maximal compression ratio were analysed using CT and signal change in the spinal cord was evaluated using MRI. The patients' age was found to be significant (p = 0.001). No difference was found between gender and the range of movement in the two groups. The maximum compression of the spinal canal showed a difference (p = 0.03). The signal change of the spinal cord was different between the two groups. In patients with OPLL of the cervical spine, myelopathic symptoms are not related to the range of movement or the number of involved segments.     

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。     

Conservatively treated ossification of the posterior longitudinal ligament increases the risk of spinal cord injury: a nationwide cohort study

The optimal treatment strategy for ossification of the posterior longitudinal ligament (OPLL) depends on symptoms and is uncertain. Whether the risk of spinal cord injury (SCI) is increased in patients with cervical spinal stenosis or myelopathy caused by OPLL remains unclear. This study aimed to evaluate the risk of SCI in patients with OPLL of the cervical spine when managed with conservative treatment (no surgery). Study subjects were identified from a nationwide cohort of 26,544,883 people from 1998 to 2005 and were divided into the OPLL group (n=265), who were hospitalized for OPLL but had conservative treatment (no surgery), and the comparison group (n=5339), composed of age- and sex-matched people. Until the end of 2008, a total of 5604 subjects were followed-up for 34,723.5 person-years. The propensity score method was used to adjust for covariates. Kaplan-Meier and Cox regression analyses were performed. The incidence rate of cervical SCI in the OPLL group was found to be significantly higher than in the comparison group (4.81 versus 0.18 per 1000 person-years; p<0.001). Cervical SCI was more likely to happen in the OPLL group than in the comparison group (crude hazard ratio [HR] 25.64; p<0.001). After adjustments, the OPLL group had a 32.16-fold (p<0.001) higher risk for cervical SCI. Disability caused by SCI had an even higher risk (HR=110.72, adjusted HR=104.78; p<0.001) for the OPLL group. Therefore, cervical SCI and related disabilities are more likely to happen in OPLL patients, who should be cautioned for subsequent SCI if treated conservatively.     

Cervical ossification of the posterior longitudinal ligament: Biomechanical analysis of the influence of static and dynamic factors

Objective

Cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) is induced by static factors, dynamic factors, or a combination of both. We used a three-dimensional finite element method (3D-FEM) to analyze the stress distributions in the cervical spinal cord under static compression, dynamic compression, or a combination of both in the context of OPLL.

Methods

Experimental conditions were established for the 3D-FEM spinal cord, lamina, and hill-shaped OPLL. To simulate static compression of the spinal cord, anterior compression at 10, 20, and 30% of the anterior–posterior diameter of the spinal cord was applied by the OPLL. To simulate dynamic compression, the OPLL was rotated 5°, 10°, and 15° in the flexion direction. To simulate combined static and dynamic compression under 10 and 20% anterior static compression, the OPLL was rotated 5°, 10°, and 15° in the flexion direction.

Results

The stress distribution in the spinal cord increased following static and dynamic compression by cervical OPLL. However, the stress distribution did not increase throughout the entire spinal cord. For combined static and dynamic compression, the stress distribution increased as the static compression increased, even for a mild range of motion (ROM).

Conclusion

Symptoms may appear under static or dynamic compression only. However, under static compression, the stress distribution increases with the ROM of the responsible level and this makes it very likely that symptoms will worsen. We conclude that cervical OPLL myelopathy is induced by static factors, dynamic factors, and a combination of both.     

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。