【摘要】 目的 探讨颈椎后纵韧带骨化症(OPLL)的CT表现及其诊断价值。 方法 回顾性分析2004年11月-2009年10月收治的6 480例颈椎患者的CT图像资料，观察后纵韧带骨化块的形态、位置及与椎管的关系，计算椎管狭窄率。 结果 6 480例颈椎CT图像中，37例发现OPLL，占0.57%（37/6 480）。颈椎后纵韧带骨化块表现为点状、条状、线状、平板状、山丘状、蕈伞状及花边状，呈现局限型、节段型、连续型、混合型特点。C4、C5及C6为颈椎后纵韧带骨化常见位置。骨化块平均厚度为4.12 mm，骨化块致椎管矢状径狭窄率为10.20%～49.18%，多位于椎管前方中间位置。椎管狭窄率gt;34.10%，临床症状明显。 结论 CT检查能较好地显示颈椎后纵韧带骨化块的特征及椎管的狭窄程度，是临床医生选择手术方案和术后评估预后的一种较好方法。【Abstract】 Objective To study the CT manifestations of ossification of posterior longitudinal ligament (OPLL) and to evaluate diagnostic value. Methods Retrospective analysis was made on the cervical spine CT images of 6 480 cases, and 37 cases of OPLL were found. The shape, location of the ossification pieces and the sagital diameter of cervical spinal canal and the stenotic rate were observed and measured. Results The ossified pieces were manifested as dots, belts, lines, boards, mounds, mushrooms and flower margins in shape. They were continuous, segmental, solitary or mixed. OPLL usually was found at C4, C5 and C6. The average thickness of the ossified pieces was 4.12 mm. The spinal stenotic rate ranged from 10.20% to 49.18% due to OPLL. The ossified pieces were often found at the middle of the back edge of cervical vertebrae bodies. There were obvious symptoms when the stenotic rate of sagital diameter of cervical spinal canal was over 34.10%. Conclusion CT is an optimal modality for diagnosis of OPLL of cervical spine and cervical spinal stenosis, and may help the clinicians to select or valuate operation project.
ObjectiveTo explore the effect of spinal dural release on the effectiveness of expansive cervical laminoplasty for treating multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament. MethodsA retrospective analysis was made on the clinical data of 32 patients with multi-segmental cervical myelopathy with cervical ossification of posterior longitudinal ligament who underwent expansive cervical laminoplasty and spinal dural release between February 2011 and October 2013 (group A); and 36 patients undergoing simple expansive cervical laminoplasty between January 2010 and January 2011 served as controls (group B). There was no significant difference in gender, age, disease duration, affected segments, combined internal disease, preoperative cervical curvature, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score between 2 groups (P>0.05). Postoperative JOA score and improvement rate, VAS score, posterior displacement of the spinal cord, and the change of cervical curvature were compared between 2 groups. ResultsSpinal dural tear occurred in 3 cases (2 cases in group A and 1 case in group B) during operation. Cerebrospinal fluid leakage occurred in 3 cases (2 cases in group A and 1 case in group B) after operation. The patients were followed up 12-46 months (mean, 18.7 months). At last follow-up, the JOA score and VAS score were significantly improved in 2 groups when compared with preoperative scores (P<0.05). JOA score and improvement rate of group A were significantly higher than those of group B (P<0.05), but VAS score of group A was significantly lower than that of group B (P<0.05). At last follow-up, no significant difference in cervical curvature was found between 2 groups (P>0.05); posterior displacement of the spinal cord of group A was significantly larger than that of group B (P<0.05). No reclosed open-door was observed during follow-up. ConclusionFor patients with multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament, full spinal dural release during expansive cervical laminoplasty can increase the posterior displacement of spinal cord, and significantly improve the effectiveness.
Objective To evaluate the feasibility, safety, and early effectiveness of percutaneous endoscopic thoracic spine surgery via the trench technique for ventral decompression in central calcified thoracic disc herniation (CCTDH) and thoracic ossification of the posterior longitudinal ligament (T-OPLL). MethodsSeven patients with single-segment CCTDH or T-OPLL admitted between June 2017 and May 2020 and meeting the selection criteria were retrospectively analyzed. There were 3 males and 4 females with an average age of 51.7 years ranging from 41 to 62 years. There were 2 patients with T-OPLL (T1, 2 in 2 cases) and 5 patients with CCTDH (T1, 2 in 1 case, T7, 8 in 1 case, T10, 11 in 2 cases, T11, 12 in 1 case). Five patients with thoracic axial pain and intercostal neuralgia had a preoperative visual analogue scale (VAS) score of 6.0 (5.0, 6.5), and 7 patients had a preoperative Japanese Orthopaedic Association (JOA) score of 21 (21.0, 22.0). Transforaminal approach was used in 4 cases and transpedicular approach in 3 cases. Ventral decompression of thoracic spinal cord was performed by thoracic endoscopy combined with trench technique. The operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications were recorded. Thoracic spine CT and MRI were performed preoperatively and postoperatively to evaluate the surgical decompression, VAS score was used to evaluate the pain of thoracic back and lower limbs, and JOA score was used to evaluate the functional recovery. Modified MacNab criteria was used to evaluate the effectiveness. ResultsAll surgeries were successfully completed. The operation time ranged from 60 to 100 minutes, with an average of 80.4 minutes; the intraoperative blood loss ranged from 40 to 75 mL, with an average of 57.1 mL; the postoperative hospital stay ranged from 4 to 7 days, with an average of 5.4 days. CT and MRI examinations indicated that the decompression was adequate. All 7 patients were followed up 3-22 months, with an average of 13.3 months. One case developed postoperative wound infection, and 1 case developed pneumonia; the remaining patients did not have any complications such as wound infection or cerebrospinal fluid leakage. Five patients with thoracic axial pain and intercostal neuralgia had VAS scores of 2.0 (1.5, 2.5) at 1 day after operation and 2.0 (1.0, 2.0) at last follow-up, both of which were significantly lower than the preoperative scores (P<0.05). At 1 day after operation, the JOA scores for all 7 patients were 22.0 (21.0, 24.0), which showed no significant difference compared to the preoperative score (P>0.05); however, at last follow-up, the score improved to 24.0 (24.0, 26.0), which was significant compared to the preoperative scores (P<0.05). At last follow-up, the effectiveness was assessed using the modified MacNab criteria, the results were excellent in 2 cases, good in 3 cases, fair in 2 cases, and the excellent and good rate was 71.4%.ConclusionUsing the trench technique, percutaneous endoscopic thoracic spine surgery can achieve the ventral decompression in CCTDH and T-OPLL, providing a new approach for surgical treatment of CCTDH and T-OPLL.
ObjectiveTo explore the safety of ultrasonic osteotome used in posterior cervical laminectomy decompression surgery and its effect on surgical outcome. Methods A clinical data of 52 patients with ossification of posterior longitudinal ligament of cervical spine (C-OPLL) undergoing posterior cervical laminectomy decompression and fusion (PCLDF) between April 2013 and April 2017 was retrospectively analysed. The patients were divided into two groups according to whether using the ultrasonic osteotome during operation: group A (20 cases, ultrasonic osteotome group) and group B (32 cases, traditional gun-clamp decompression group). There was no significant difference in gender, age, body weight, height, preoperative hemoglobin, and Japanese Orthopedic Association (JOA) score between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time, complications, hemoglobin at 1 day after operation, and JOA score at 6 months after operation were recorded and compared between the two groups, and the improvement rate of JOA was calculated. Results The operation time and intraoperative blood loss in group A were significantly less than those in group B (P<0.05); there was no significant difference in the drainage volume and hospitalization time between the two groups (P>0.05). The hemoglobin of group B was slightly higher than that of group A at 1 day after operation, but there was no significant difference between the two groups (t=–1.260, P=0.214). All the patients were followed up 6-10 months (mean, 7.6 months). No serious complications such as C5 nerve paralysis, dural tear, infection, epidural hematoma, deep venous thrombosis, pulmonary embolism, transfusion allergy, or shock occurred during and after operation. The JOA scores of the two groups were significant improved at 6 months after operation when compared with preoperative scores (P<0.05), and there was no significant difference in JOA score and improvement rate between the two groups at 6 months after operation (P>0.05). Conclusion Compared with the traditional gun-clamp decompression, the effectiveness of PCLDF in treatment of C-OPLL by using ultrasonic osteotome is comparable, but the latter can effectively reduce the operation time and blood loss.
Objective To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C2 segment. Methods The literature about the surgery for cervical OPLL involving C2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized. Results For cervical OPLL involving the C2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification. Conclusion OPLL involving the C2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C2 segment.
Objective To investigate an individualized treatment program of a patient with multilevel cervical spondylotic myelopathy by the method of evidence-based medicine. Methods One patient with multilevel cervical spondylotic myelopathy was admitted into West China Hospital on October 19th, 2015. After evaluating the patient’s condition adequately, we proposed the problem according to the " patient, intervention, control, and outcome” (PICO) principles. Then, we searched and evaluated the systematic reviews, randomized controlled trials (RCTs), cohort studies from Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Medline, Embase, PubMed, OVID ACP Journal Club, CNKI, Wanfang and so on. The search date was from January 1991 to December 2015. And the best evidences from the databases were utilized in clinical practice. Results Twelve studies (five systematic reviews, two RCTs, four cohort studies and one latest guideline) were listed. To patients with multilevel cervical spondylotic myelopathy with ossification of the posterior longitudinal ligament (OPLL), posterior laminoplasty was less traumatic and had less complication. Expansive open-door laminoplasty was better. And the use of mini-plate fixation also reduced the related complications. Conclusions Posterior expansive open-door laminoplasty with mini-plate fixation has less traumatic and complication incidence, which can treat multilevel cervical spondylotic myelopathy effectively. For the best results and avoiding adverse outcomes, the procedure should be preferred in patients with OPLL.
Objective To investigate the microscope-assisted anterior cervical surgery and traditional open surgery for the treatment of cervical myelopathy with ossification of the posterior longitudinal ligament (OPLL). Methods Retrospective selection of patients with OPLL who underwent microscope-assisted and traditional open anterior cervical surgery in West China (Airport) Hospital Sichuan University were selected between January 2016 and August 2020. The patients who underwent traditional open anterior cervical surgery between January 2016 and August 2018 were classified as the conventional group, and the patients who underwent microscope-assisted anterior cervical surgery between September 2018 and August 2020 were classified as the microscope group. The baseline characteristics, operative time, intraoperative blood loss, length of hospital stay, Visual Analogue Scale (VAS) of pain before and after surgery, and surgical complications were collected. Neurological function was assessed using the Japanese Orthopaedic Association (JOA) score. Result A total of 46 patients were included. There were 24 cases in the conventional group and 22 cases in the microscope group. There was no significant difference in baseline characteristics between the two groups (P>0.05). The operation time, intraoperative blood loss and length of hospital stay in the microscope group were lower than those in the conventional group (P<0.001). There was no significant difference in VSA score and JOA score between the two groups before operation (P>0.05). There were statistically significant differences in VAS score and JOA score between the two groups 18 months after operation (P<0.001). The comparison of VAS score and JOA score in the two groups before and after operation showed that there was a statistically significant difference between 18 months after operation and before operation (P<0.05). In the microscope group, the average improvement rate of neurological function [(79.90±16.67)% vs. (58.12±17.47)%, t=4.317, P<0.001], excellent and good rate [95.45% (21/22) vs. 66.67% (16/24), χ2=4.354, P=0.037] were higher than those in the conventional group. The total number of complications in the microscope group was lower than that in the conventional group (P=0.024). Conclusion Compared with the traditional open anterior cervical surgery, the microscope-assisted anterior cervical surgery for OPLL can reduce intraoperative blood loss and length of hospital stay, reduce the incidence of postoperative complications.
Objective To evaluate the effectiveness of using titanium alloy trabecular bone three-dimensional (3D) printed artificial vertebral body in treating cervical ossification of the posterior longitudinal ligament (OPLL). Methods A retrospective analysis was conducted on clinical data from 45 patients with cervical OPLL admitted between September 2019 and August 2021 and meeting the selection criteria. All patients underwent anterior cervical corpectomy and decompression, interbody bone graft fusion, and titanium plate internal fixation. During operation, 21 patients in the study group received titanium alloy trabecular bone 3D printed artificial vertebral bodies, while 24 patients in the control group received titanium cages. There was no significant difference in baseline data such as gender, age, disease duration, affected segments, or preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), vertebral height, and C2-7 Cobb angle (P>0.05). Operation time, intraoperative blood loss, and occurrence of complications were recorded for both groups. Preoperatively and at 3 and 12 months postoperatively, the functionality and symptom relief were assessed using JOA scores, VAS scores, and NDI evaluations. The vertebral height and C2-7 Cobb angle were detected by imaging examinations and the implant subsidence and intervertebral fusion were observed. Results The operation time and incidence of complications were significantly lower in the study group than in the control group (P<0.05), while the difference in intraoperative blood loss between the two groups was not significant (P>0.05). All patients were followed up 12-18 months, with the follow-up time of (14.28±4.34) months in the study group and (15.23±3.54) months in the control group, showing no significant difference (t=0.809, P=0.423). The JOA score, VAS score, and NDI of the two groups improved after operation, and further improved at 12 months compared to 3 months, with significant differences (P<0.05). At each time point, the study group exhibited significantly higher JOA scores and improvement rate compared to the control group (P<0.05); but there was no significantly difference in VAS score and NDI between the two groups (P>0.05). Imaging re-examination showed that the vertebral height and C2-7 Cobb angle of the two groups significantly increased at 3 and 12 months after operation (P<0.05), and there was no significant difference between 3 and 12 months after operation (P>0.05). At each time point, the vertebral height and C2-7 Cobb angle of the study group were significantly higher than those of the control group (P<0.05), and the implant subsidence rate was significantly lower than that of the control group (P<0.05). However, there was no significant difference in intervertebral fusion rate between the two groups (P>0.05). Conclusion Compared to traditional titanium cages, the use of titanium alloy trabecular bone 3D-printed artificial vertebral bodies for treating cervical OPLL results in shorter operative time, fewer postoperative complications, and lower implant subsidence rates, making it superior in vertebral reconstruction.
Objective To explore the safety and effectiveness of multisegmental thoracic ossification of posterior longitudinal ligament (T-OPLL) treated by laminectomy, posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system. Methods The clinical data of 8 patients with multisegmental T-OPLL treated with laminectomy, posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system between January 2020 and April 2023 was retrospectively analyzed. There were 3 males and 5 females; the age ranged from 41 to 67 years, with a mean of 57.1 years. The disease duration ranged from 3 to 74 months, with a mean of 33.4 months. Symptoms were progressive numbness and weakness of both lower limbs, unsteady walking, chest and back pain in 3 cases, and urinary and bowel dysfunction in 5 cases; 7 cases showed increased muscle strength of the lower limbs, hyperreflexia of the tendons, and a positive Babinski sign, and 1 case showed decreased muscle strength of the lower limbs, decreased skin sensation, decreased knee and Achilles tendon reflexes, and a negative pathologic sign. Multisegmental posterior longitudinal ligament ossification of thoracic spine was found in 8 cases, with 4-8 segments of ossification, and in 5 cases with multisegmental ossification of the ligamentum flavum. The preoperative Japanese Orthopaedic Association (JOA) thoracic spinal function score was 4.3±0.9, the visual analogue scale (VAS) score was 6.9±1.0, and the the kyphotic Cobb angle of the stenosis segment was (34.62±10.76)°. The operation time, intraoperative blood loss, and complications were recorded. VAS score was used to evaluate the back pain, JOA score was used to evaluate the thoracic spinal cord function and the JOA improvement rate was calculated, and the kyphotic Cobb angle of the stenosis segment was measured and the Cobb angle improvement rate was calculated. Results The operation time ranged from 210 to 340 minutes, with a mean of 271.62 minutes; intraoperative blood loss ranged from 900 to 2 100 mL, with a mean of 1 458.75 mL; the number of resected vertebral plates ranged from 4 to 8, with a mean of 6.1; dural tears and cerebrospinal fluid leakage occurred in 3 cases, and the incisions healed by first intention. All 8 cases were followed up 12-26 months, with a mean of 18.3 months. There was no complication such as loosening of internal fixator, breakage of screws and rods, and no significant progress of ossification. At last follow-up, the VAS score was 1.4±0.7, the JOA thoracic spinal function score was 9.8±0.7, and the the kyphotic Cobb angle of the stenosis segment was (22.12±8.28)°, all of which significantly improved when compared with preoperative ones (t=11.887, P<0.001; t=13.015, P<0.001; t=7.395, P<0.001). The JOA improvement rate was 81.06%±10.93%, of which 5 cases were rated as excellent and 3 cases as good; the Cobb angle improvement rate was 36.51%±14.20%. Conclusion Laminectomy, posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system is a safe, effective, and simple method for the treatment of multisegmental T-OPLL, which is a feasible option.
Objective To review the research progress of bone morphogenetic protein (BMP) and the liability of ossification of the posterior longitudinal ligament (OPLL). Methods Recent literature concerning BMP and the liability of OPLL was reviewed, analysed, and summarized. Results The single nucleotide polymorphisms (SNPs) of BMP gene may produce a minor cumulative effect and increase individual susceptibility to OPLL. A variety of environmental factors can promote the occurrence and development of OPLL by increasing the expression of BMP gene. Conclusion The SNPs of BMP gene may increase individual susceptibility to OPLL. However, interaction of cumulative effect of the SNPs and environmental factors can promote the liability to OPLL.