Schizophrenic Psychosis with a Tendency of Systemic Ossification

Abstract: We report here a case of schizophrenic psychosis with a tendency of systemic ossification. Upon further examinations, she exhibited ossification of the spinal ligament (diffuse idiopathic skeletal hyperostosis, DISH) resulting from a coappearance of ossification of the posterior longitudinal ligament (OPLL), ossification of the yellow ligament (OYL) and ankylosing spinal hyperostosis (ASH). There have been a very few reports where a tendency of hyperostosis was observed for ossification of the spinal ligaments such as OPLL, OYL and ASH. In addition, she exhibited hyperostosis frontalis interne (HFI). It appears in this case that both DISH and HFI resulted from similar ossification and exhibited respective clinical symptoms. Although it is thought that these diseases resulted from some metabolic abnormality, no abnormality was detected.     

An ultrastructural study on the ligamentum flavum of the cervical spine in patients with ossification of the posterior longitudinal ligament

Some histological analyses of the ossification of the posterior longitudinal ligament (OPLL) have been reported, but no ultrastructural studies of the ligamentum flavum (LF) in patients with OPLL have been published to date. To understand the pathology of the ossification of the spinal ligament, we examined, by electron microscopy, ultrastructural changes in the LF in cases of OPLL and made a comparison with the LF in cervical spondylotic myelopathy (CSM). Subjects were three men and two women with cervical OPLL who underwent longitudinal spinous process-splitting laminoplasty. During surgery, a small piece of the LF was collected from C2–C3 to C7–T1 and was then analyzed by light and electron microscopy. We observed atrophic elastic bundles with a two-layer structure and disarrangement, a partially torn area, the disappearance of microfibrils, and an enlarged interstitium with an irregular alignment of collagen fibrils. We observed some properties of a cell preceding its death: the initial phase may be the disappearance of the plasma-membrane, followed by the scattering of many organellae around its degenerated nucleus. Finally, many extracellular plasma membrane-invested particles that resemble matrix vesicles remain there without phagocytosis. These results suggest that ultrastructural abnormalities exist in the spinal ligament in cases of ossification of the spinal ligament.     

发育性颈椎管狭窄症合并颈椎后纵韧带骨化症

本文报告了发育性颈椎管狭窄症合并颈椎后纵韧带骨化症（OPLL）38例，手术治疗37例，影像学显示椎管与椎体矢状径比值最窄为0.48:1，最宽为0.72:1，平均0.65:1。合并OPLL，其狭窄率最低为18%，最高为68A%，平均为41.5%。手术方法：颈前路减压 植骨融合术13例；颈后路减压30例次，包括半椎板减压14例次，全椎板减压5例，椎管成形术11例次，随讠9例，平均随访时间20个月，按“颈椎病脊髓功能状态评定法”进行疗效评定，术前平均21.45分，术后32.31分，平均改善率72.09%。     

Bath ankylosing spondylitis functional index (BASFI) evaluation of postoperative patients with OPLL

Although surgical decompression of the involved spinal cord achieves a good recovery of neurological conditions, one of the most important complaints of patients with ossification of the posterior longitudinal ligament (OPLL) is disability as a result of spinal immobility. The activities of daily living (ADL) of postoperative patients with OPLL were examined. To evaluate the ADL of postoperative patients with OPLL in the cervical spine, we utilized the Bath Ankylosing Spondylitis Functional Index (BASFI), one of the most widely used functional indexes for ankylosing spondylitis. We investigated consecutive cases that underwent surgery for OPLL of the cervical spine in our department from 1978 to 1998. The latest and postoperative scores were compared to the preoperative Japanese Orthopaedic Association (JOA) scores (range, 0–17) to assess neurological recovery. We also evaluated ADL at the latest follow-up, using BASFI scores. Significant recoveries of JOA scores were confirmed; however, 77% of patients complained of disability. In BASFI, questions that seemed to reflect spinal condition received low scores in the present study. BASFI scoring was not sufficient in the present form; however, it is one of the candidate functional indexes for evaluating ADL in postoperative patients with OPLL. Establishment of an ideal functional index for such evaluation is needed.     

颈椎前路椎体骨化物复合体前移融合术治疗严重颈椎后纵韧带骨化症

目的 报道一项治疗严重颈椎后纵韧带骨化症的新技术,可在不切除骨化物的前提下实现神经的直接减压,弥补传统前路或后路减压手术的不足.方法 颈椎前路椎体骨化物复合体前移融合术的手术操作步骤主要包括处理椎间隙、去除椎体前部骨质、安装钛板和椎间融合器、椎体两侧开槽和椎体骨化物复合体前移等.收集2例经该术式治疗的严重颈椎后纵韧带骨化症患者的临床资料并进行分析.结果 颈椎前路椎体骨化物复合体前移融合术通过将椎体骨化物复合体游离并前移,实现脊髓和神经根的直接减压.2例患者手术顺利,脊髓减压彻底,神经功能恢复良好,无特殊并发症发生.结论 颈椎前路椎体骨化物复合体前移融合术的设计兼顾了前路直接减压的有效性和后路间接减压的安全性,初步疗效证明其可作为严重颈椎后纵韧带骨化症的一种治疗方案.     

单开门椎管成形术联合微型钛板固定治疗连续型后纵韧带骨化症

目的探讨单开门椎管成形术联合微型钛板固定治疗连续型后纵韧带骨化症的疗效。方法选择本院2005年1月～2010年1月收治的15例OPLL患者,采用后路单开门椎管成形术联合微型钛板固定治疗,所有患者随访24个月,分析JOA评分、颈椎曲度、颈椎矢状径术前术后的改善情况。结果所有患者均成功随访,术后患者JOA平均改善率为（61.3±19.2）%,影像学检查显示无＂再关门＂现象的发生。JOA评分、颈椎矢状径均较术前明显改善,差异有统计学意义（P〈0.05）。结论单开门椎管成形术联合微型钛板固定治疗连续型OPLL疗效确切,能维持颈椎的稳定性,保持椎管的扩张状态,是一种治疗连续型OPLL的有效方法。     

Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient database

BACKGROUND CONTEXT

Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications.

Wound-peritoneal shunts: part of the complex management of anterior dural lacerations in patients with ossification of the posterior longitudinal ligament

Background

The complex management of dural lacerations occurring after the resection of multilevel ossification of the posterior longitudinal ligament (OPLL) requires further clarification.

Methods

Both preoperative MR and CT studies documented multilevel ventral cord compression attributed to OPLL with kyphosis in 82 patients requiring multilevel anterior corpectomy/fusion (ACF) (average, 2.6 levels) followed by posterior fusion (PF) (average, 6.6 levels) under the same anesthetic. The 5 patients who developed intraoperative dural lacerations/penetration demonstrated the single-layer sign (2 patients: large central mass) or the double-layer sign (3 patients: hyperdense/hypodense/hyperdense layers) on preoperative 2-dimensional CT studies. All 5 patients were managed with complex dural repair (sheep pericardial grafts, fibrin sealant, microfibrillar collagen) and had shunts placed (wound-peritoneal and lumboperitoneal).

Results

After complex dural repair/shunting, all 5 intraoperative dural lacerations (DLs) resolved. The application of low-pressure wound-peritoneal shunts was unique to this study (Uni-Shunts, Codman, Johnson and Johnson, Dorchester, Mass). The proximal end is placed lateral/parallel to the fibula strut graft/plate complex, whereas the distal catheter is tunneled into the peritoneum in the right upper quadrant (always prepared and draped in anticipation of the need for a shunt).

Conclusions

Of 82 patients undergoing multilevel anterior corpectomy for OPLL/kyphosis, 5 developed intraoperative DLs successfully managed with a complex dural repair, wound-peritoneal, and lumboperitoneal shunting procedures.     

胸椎管狭窄症的诊断和治疗

目的: 总结胸椎管狭窄症的临床特点, 加强对胸椎管狭窄症临床特点的认识。方法: 回顾总结获随访 120例经过手术治疗的胸椎管狭窄症患者的临床资料。98例行椎管后壁切除术, 侧前方入路行胸椎间盘或胸椎后纵韧带骨化病灶切除 17例 (其中经胸腔入路 7例, 经胸膜外或胸腹膜外 10例), 后路环椎管减压术 5例。随访时间最长 64个月, 最短 3个月, 平均 28个月。结果: 功能评定采用改良的Epstein评分标准, 优 51例, 良 42例, 改善 17例, 差 10例。优良率为 77. 5%。结论: 退变性胸椎管狭窄症症状复杂多样, 手术治疗是唯一选择。根据胸椎管狭窄症的不同病理改变选择手术方式, 可获得满意的效果。     

颈椎后路三种手术方式对改善多节段颈椎病生理曲度及疗效的远期观察

[目的]本研究通过回顾性分析行颈椎后路手术的多节段脊髓型颈椎病合并后纵韧带骨化(ossificationofposteriorlongitudinalligament.OPLL)患者的颈椎曲率变化、JOA评分改善率以及颈肩轴性痛VAS评分改善率,比较颈椎后路三种手术方式对改善颈椎曲度、神经功能及轴性症状的远期影响.[方法]根据手术方式分三组:A组颈椎后路单开门椎管扩大成形术29例,B组颈椎后路全椎板切除术23例,C组颈椎后路全椎板切除侧块螺钉内固定术26例,记录术前、术后的颈椎曲度、JOA评分及轴性症状等.[结果]JOA评分改善率:3组患者术后与术前相比均有统计学意义(P＜0.05).末次随访时c组最高.颈椎曲度改善率:C组最好,A组次之,B组最差.并发症发生情况:在轴性症状上,3组的VAS评分两两比较有统计学意义(P＜0.05),B组最高,A组次之,C组最低.[结论]采用颈椎后路三种手术方式治疗多节段脊髓型颈椎病合并OPLL均能达到良好的疗效.颈椎后路全椎板切除侧块螺钉内固定术可有效改善神经功能,恢复和保持颈椎曲度,降低轴性症状及C5神经根麻痹发生率.