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Investigation on anatomical factors inhibiting the posterior shift of the thoracic spinal cord and the development of reliable methods of posterior decompression of the spinal cord for the thoracic OPLL-myelopathy

抑制胸段脊髓后移的解剖因素的研究及治疗胸段后纵韧带骨化脊髓病的可靠脊髓后路减压方法的开发

基本信息

批准号：
10671378
负责人：
TSUZUKI Nobuyuki
金额：
$ 1.73万
依托单位：
Saitama Medical School
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1998
资助国家：
日本
起止时间：
1998 至 1999
项目状态：
已结题

项目摘要

As a method of safe and reliable decompression of the spinal cord for thoracic-OPLL myelopathy, the posterior approach was selected and its disadvantage, I.e., the insufficient degree of decompression caused by thoracic kyphosis, was improved by elimination of three major anatomical factors which inhibited the posterior shift of the thoracic spinal cord. They were: (1) longitudinal factor, I.e., anterior pulling effects of spinal cord segments, above and below OPLL, (2) longitudotransverse factor, I.e., holding-down effect of the parts of dura; mid-dorsal part and lateral part which extended into nerve-sheath, (3) transverse factor, I.e., anterior tethering effect of thoracic roots and denticular ligaments. Means of elimination of these factors were: (1) extensive cervicothoracic laminoplastic decompression, (2) longitudinal durotomy, (3) facetectomy and root-OPLL release. OPLL resection or anterior transfer was finally performed if necessary. These procedures were performed through staged posterior approaches in fifteen cases of thoracic OPLL-myelopathy. A mean age was 56 years (range: 42-68 years) and a mean follow-up was 42 months (range: 5-100 months). Neurology improved in all cases, with little postoperative complications. Radiological pictures proved the effectiveness of elimination of posterior-shift-inhibiting factors for the spinal cord decompression.

作为一种安全可靠的胸OPLL脊髓病脊髓减压方法，选择了后路，其缺点是，通过消除抑制胸段脊髓后移的三个主要解剖因素，改善了胸椎后凸引起的减压不足程度。它们是：（1）纵向因素，即，OPLL上、下脊髓节段的前牵拉效应;（2）脊髓横突因素，即，（3）横向因素，即硬膜的中背侧部和外侧部伸入神经鞘的压迫作用;胸神经根和齿状韧带的前栓系作用。消除这些因素的方法有：（1）广泛的颈胸椎板成形减压，（2）纵向硬脑膜切开术，（3）关节突切除术和根OPLL松解。必要时行OPLL切除或前路转移。这些手术是通过分期后路手术在15例胸椎OPLL脊髓病中进行的。平均年龄为56岁（范围：42 - 68岁），平均随访时间为42个月（范围：5 - 100个月）。所有病例的神经功能均得到改善，术后并发症很少。影像学检查证实了脊髓后移抑制因素的消除对脊髓减压的有效性。