Acute Cervical Spinal Cord Injury Complicated by Preexisting Ossification of the Posterior Longitudinal Ligament A Multicenter Study
Acute Cervical Spinal Cord Injury Complicated by Preexisting Ossification of the Posterior Longitudinal Ligament A Multicenter Study
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DOI：
10.1097/brs.0b013e3181f49718
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发表时间：
2011-08-15
期刊：
影响因子：
3
通讯作者：
Nakamura, Kozo
中科院分区：
文献类型：
--
作者：
Chikuda, Hirotaka;Seichi, Atsushi;Nakamura, Kozo
研究设计.回顾性多中心研究。目的回顾性分析外伤性颈脊髓损伤（SCI）合并后纵韧带骨化（OPLL）的临床特点。尽管其潜在的破坏性后果，有一个缺乏信息的急性颈椎脊髓损伤并发OPLL。本研究纳入了日本34家脊柱机构在受伤48小时内收治的急性创伤性颈椎脊髓损伤（Frankel A、B和C）的连续患者。对于神经系统结局分析，纳入了至少完成6个月随访的患者。神经功能改善定义为Frankel分级中至少有一级转换。共确定了453例患者（367例男性，86例女性;平均年龄59岁）。106例（23%）患者（87例男性，19例女性;平均年龄66岁）发现OPLL。大多数OPLL患者（106例中的94例）没有骨损伤，表现为不完全SCI。在无骨损伤的SCI患者中，OPLL的患病率高达34%。SCI的原因主要是福尔斯（74%）。只有25%的患者知道OPLL。一半的OPLL患者在受伤前报告步态障碍。48例（52%）无骨损伤的OPLL患者接受了手术（中位数，损伤后13.5天），主要是椎板成形术。总体而言，手术组和保守组之间的神经功能改善无显著差异。然而，进一步分层显示，在伤前有步态障碍的患者中，手术与更大的神经功能恢复相关（P = 0.04）。颈部SCI中OPLL的患病率高得惊人，尤其是在没有骨损伤的患者中。大多数颈椎脊髓损伤合并后纵韧带骨化是不完全的，没有骨损伤，主要是由低能量创伤引起的。大多数患者不知道OPLL。手术对伤前有步态障碍的患者神经功能恢复较好。
Study Design. Retrospective multicenter study.Objective. To review the clinical characteristics of traumatic cervical spinal cord injury (SCI) associated with ossification of the posterior longitudinal ligament (OPLL).Summary of Background Data. Despite its potentially devastating consequences, there is a lack of information about acute cervical SCI complicated by OPLL.Methods. This study included consecutive patients with acute traumatic cervical SCI (Frankel A, B, and C) who were admitted within 48 hours of injury to 34 spine institutions across Japan. For analysis of neurologic outcome, patients who had completed at least a 6-month follow-up were included. Neurologic improvement was defined as at least one grade conversion in Frankel grade.Results. A total of 453 patients were identified (367 men, 86 women; mean age, 59 years). OPLL was found in 106 (23%) patients (87 men, 19 women; mean age, 66 years). Most of the patients with OPLL (94 of 106) were without bone injury, presenting with incomplete SCI. The prevalence of OPLL reached 34% in SCI without bone injury. The cause of SCI was predominantly falls (74%). Only 25% of the patients were aware of OPLL. Half of the OPLL patients reported gait disturbance before injury. Forty-eight (52%) OPLL patients without bone injury underwent surgery (median, 13.5 days after injury), mostly laminoplasty. Overall, no significant difference was noted in neurologic improvement between surgery group and conservative group. However, further stratification showed that surgery was associated with greater neurologic recovery in patients who had gait disturbance before injury (P = 0.04).Conclusion. Prevalence of OPLL among cervical SCI was alarmingly high, especially in those without bone injury. Most of cervical SCI associated with OPLL were incomplete, without bone injury, and caused predominantly by low-energy trauma. The majority of the patients were unaware of OPLL. Surgery produced better neurologic recovery in patients who had gait disturbance before injury.