How does the ossification area of the posterior longitudinal ligament thicken following cervical laminoplasty?
How does the ossification area of the posterior longitudinal ligament thicken following cervical laminoplasty?
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DOI：
10.1097/brs.0b013e31814614f3
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发表时间：
2007-09-01
期刊：
影响因子：
3
通讯作者：
Kimura, Tomoatsu
中科院分区：
文献类型：
--
作者：
Hori, Takeshi;Kawaguchi, Yoshiharu;Kimura, Tomoatsu
研究设计。回顾性案例系列。目的。研究颈椎椎板成形术后骨化区域厚度随时间的进展。背景数据摘要。颈椎椎板成形术已成为治疗后纵韧带骨化（OPLL）所致脊髓病患者的标准技术。然而，后纵韧带骨化是一种进行性疾病，椎板成形术后骨化面积的增加会影响手术结果。迄今为止，尚未对 OPLL 进展的厚度进行完整分析，因为与纵轴相比，骨化厚度的变化较小。方法。包括 55 名在颈椎椎板成形术后 5 年以上可进行系列 X 光检查的患者。使用颈椎侧位X光片和计算机软件评估骨化厚度的程度。使用日本骨科协会评分（JOA评分）对神经系统评估进行分级。分析了后纵韧带骨化（OPLL）的进展与临床和放射学数据之间的关联。我们还评估了手术后骨化区域厚度随时间的进展。结果。 12 名患者 (21.8%) 的 OPLL 厚度出现进展。混合型或连续型 OPLL 的年轻患者进展明显。 C3 受累在 OPLL 进展的患者中也很常见。 OPLL 厚度的进展与基于评分的恢复率没有直接关系。 OPLL 的进展经常在 C2、C3 和 C4 水平观察到。在 42.1% 的 C2 骨化、13.3% 的 C3、11.9% 的 C4、4.1% 的 C5、5.5% 的 C6 和 6.6% 的 C7 骨化中检测到 OPLL 厚度进展。结论。患有连续型或混合型 OPLL 且 C3 骨化受累的年轻患者存在手术后 OPLL 厚度进展的风险。由于骨化病灶厚度的增加直接导致椎管狭窄，因此在OPLL患者的手术治疗中必须关注这些危险因素以及颈椎椎管扩大成形术前后骨化的增加。
Study Design. Retrospective case series.Objective. To investigate the progression of the thickness of the ossification area over time following cervical laminoplasty.Summary of Background Data. Cervical laminoplasty has become the standard technique for the treatment of patients with myelopathy due to ossification of the posterior longitudinal ligament (OPLL). However, OPLL is a progressive disease, and an increase in the area of ossification following laminoplasty affects the surgical results. To date, complete analysis of the thickness of OPLL progression has not been undertaken because changes in the ossification thickness are minor compared with those of the longitudinal axis.Methods. Fifty-five patients who were available for serial radiographs more than 5 years after cervical laminoplasty were included. The extent of ossification thickness was assessed using lateral radiographs of the cervical spine and computer software. The neurologic evaluation was graded using the Japanese Orthopedic Association score (JOA score). The associations between the progression of OPLL and the clinical and radiologic data were analyzed. We also evaluated the progression of the thickness of the ossification area over time following surgery.Results. Twelve patients (21.8%) had progression in the OPLL thickness. Progression was marked in younger patients with the mixed or continuous types of OPLL. C3 involvement was also common in the patients with the OPLL progression. The progression of OPLL thickness was not directly related to the score-based recovery rate. The progression of OPLL was frequently observed at C2, C3, and C4 levels. Progression in OPLL thickness was detected in 42.1% of C2 ossifications, 13.3% of C3, 11.9% of C4, 4.1% of C5, 5.5% of C6, and 6.6% of C7.Conclusion. Young patients with continuous or mixed-type OPLL and C3 involvement of ossification had a risk for progression in OPLL thickness following surgery. As the increased thickness of ossified lesions directly causes the narrowing of the spinal canal, it is important to pay attention to these risk factors and the increase in ossification before and after cervical laminoplasty in the surgical treatment of patients with OPLL.