Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan.
Spine (Phila Pa 1976). 2009 Nov 1;34(23):E861-3. doi: 10.1097/BRS.0b013e3181bb89fc.
Case report and clinical discussion.
To describe technical pitfall to treat 2 cervical cord injuries, including dislocations in patients with ankylosed spine due to diffuse idiopathic skeletal hyperostosis (DISH) or ossification of the posterior longitudinal ligament (OPLL).
DISH and OPLL are disease processes similar in pathology, which can lead to unexpected fractures due to low-energy trauma. In reported cases of fracture of the ankylosed spine in patients with DISH or OPLL, increasing lever arm and a grossly unstable fracture occurred. However, the actual surgical intervention for these fractures and spinal cord injuries was not discussed.
We report 2 cervical cord injuries, including dislocations in patients with ankylosed spine due to DISH or OPLL.
Two patients underwent posterior fusion without decompression; however, postoperative progressive paraplegia still occurred. There were 3 points in common: these patients had ankylosed spines due to DISH or OPLL; they were elderly and had spinal canal stenosis; and after undergoing posterior fusion without decompression, their bilateral, lower extremity palsies worsened after surgery. Cervical alignment was slightly different after posterior fusion, and this change concentrated in one segment because adjacent vertebral bodies were ankylosed, and thus, immoveable. Additionally, this stress caused infolding of the ligamentum flavum with resultant spinal cord compression.
In these cases, we recommend posterior fusion and decompression such as laminoplasty to avoid worsening palsy.
病例报告和临床讨论。
描述治疗 2 例因弥漫性特发性骨肥厚（DISH）或后纵韧带骨化（OPLL）导致脊柱强直的颈椎脊髓损伤患者的技术难点。
DISH 和 OPLL 在病理上是相似的疾病过程，可导致低能量创伤后意外骨折。在报道的 DISH 或 OPLL 患者脊柱强直骨折病例中，杠杆臂增加且骨折极不稳定。然而，对于这些骨折和脊髓损伤的实际手术干预并未讨论。
我们报告了 2 例因 DISH 或 OPLL 导致脊柱强直的颈椎脊髓损伤患者。
2 例患者均行后路融合但未行减压术，但术后仍出现进行性截瘫。这 3 例患者有 3 个共同点：DISH 或 OPLL 导致脊柱强直；年龄较大且存在椎管狭窄；后路融合未减压后，双下肢瘫痪在术后加重。后路融合后颈椎排列略有不同，这种变化集中在一个节段，因为相邻椎体强直且无法活动。此外，这种应力导致黄韧带折叠，导致脊髓受压。
在这些病例中，我们建议行后路融合和减压术，如椎板成形术，以避免瘫痪加重。
