Cabre P, Pascal-Moussellard H, Kaidomar S, Bucki B, Bardin T, Smadja D, Arfi S
Service de neurologie, h pital Pierre-Zobda-Quitmann, CHRU Fort de France, Martinique.
Joint Bone Spine. 2001 Mar;68(2):158-65. doi: 10.1016/s1297-319x(00)00246-3.
Calcification of the ligamentum flavum at the cervical spine is an uncommon condition reported mainly in Japanese patients. We describe the clinical manifestations, imaging study findings, and outcomes in six cases seen in the French West Indies.
We retrospectively reviewed the medical charts of six patients admitted to an orthopedics department for spinal cord compression shown upon computed tomography to be caused by calcification of the ligamentu flavum. There were five women and one man, mean age at admission was 71.7 years (range, 64-79 years) and all six patients were Black.
Five patients had cervical myelopathy and one was asymptomatic. All five symptomatic patients had cervical spinal stenosis, explaining the rapid symptom onset (within six and a half months) and severe motor loss. Computed tomography reconstruction in the sagittal plane ruled out ossification of the ligamentum flavum. Magnetic resonance imaging of the neck failed to demonstrate the calcifications but was useful in evaluating the severity of the spinal cord compression. One patient had articular chondrocalcinosis in both knees and another had calcifications in the basal ganglia. Surgical decompression by the posterior route was performed in two patients and was effective in both, whereas two of the three symptomatic patients who did not have surgery experienced worsening neurological loss. Analysis of the operative specimens from the two surgically treated patients showed a mixture of calcium pyrophosphate dihydrate crystals and apatite microcrystals.
Calcification of the ligamentum flavum is probably underrecognized in blacks. This condition causes severe neurological loss. Imaging studies provide the diagnosis. The pathogenesis remains unclear.
颈椎黄韧带钙化是一种罕见疾病，主要在日本患者中报道。我们描述了在法属西印度群岛所见的6例患者的临床表现、影像学研究结果及预后。
我们回顾性分析了6例因计算机断层扫描显示脊髓受压而入住骨科的患者的病历，脊髓受压是由黄韧带钙化引起的。其中有5名女性和1名男性，入院时的平均年龄为71.7岁（范围64 - 79岁），所有6例患者均为黑人。
5例患者患有颈椎病，1例无症状。所有5例有症状的患者均有颈椎管狭窄，这解释了症状的快速发作（在六个半月内）和严重的运动功能丧失。矢状面计算机断层扫描重建排除了黄韧带骨化。颈部磁共振成像未能显示钙化，但有助于评估脊髓受压的严重程度。1例患者双膝有关节软骨钙质沉着症，另1例患者基底节有钙化。2例患者接受了后路手术减压，均有效，而3例有症状但未接受手术的患者中有2例神经功能丧失恶化。对2例接受手术治疗患者的手术标本分析显示，有二水焦磷酸钙晶体和磷灰石微晶的混合物。
黑人中黄韧带钙化可能未得到充分认识。这种情况会导致严重的神经功能丧失。影像学研究可提供诊断。其发病机制仍不清楚。
