Epstein N E, Hollingsworth R
Department of Surgery (Neurosurgery), North Shore University Hospital-New York University Medical Center, Manhasset, USA.
J Neurosurg. 1999 Apr;90(2 Suppl):261-3. doi: 10.3171/spi.1999.90.2.0261.
The authors evaluated the clinical, radiological, and surgical management of ossification of the anterior longitudinal ligament (OALL) that contributed to dysphagia in a patient with simultaneous cervical ossification of the posterior longitudinal ligament (OPLL). A 57-year-old man presented with increasing dysphagia and moderate myelopathy. Imaging studies, including esophagoscopy, revealed marked esophageal compression due to OALL that extended between the C2-5 levels and significant C5-7 OPLL that compressed the distal cervical spinal cord. The use of rongeurs and a high-speed drill facilitated excision of the C2-5 OALL mass, and a routine anterior corpectomy with fusion was performed at the C5-7 level. Postoperatively, the patient's dysphagia and symptoms of myelopathy immediately resolved. The strut graft became fully fused 3 months postoperatively, as demonstrated on dynamic x-ray films, and the patient has remained asymptomatic 4 months postoperatively. Patients with dysphagia and coexisting myelopathy benefit from simultaneous surgery for resection of OALL and OPLL masses.
作者评估了一例同时患有颈椎后纵韧带骨化（OPLL）且前纵韧带骨化（OALL）导致吞咽困难患者的临床、影像学及手术治疗情况。一名57岁男性患者出现吞咽困难加重及中度脊髓病症状。包括食管镜检查在内的影像学研究显示，OALL导致显著的食管受压，该病变累及C2至C5节段，同时C5至C7节段存在明显的OPLL，压迫颈髓远端。使用咬骨钳和高速钻头辅助切除了C2至C5节段的OALL肿块，并在C5至C7节段进行了常规前路椎体次全切除融合术。术后，患者的吞咽困难和脊髓病症状立即缓解。术后3个月动态X线片显示支撑植骨完全融合，术后4个月患者一直无症状。吞咽困难合并脊髓病的患者可通过同时手术切除OALL和OPLL肿块而获益。
