Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.
Spine (Phila Pa 1976). 2011 Aug 15;36(18):1453-8. doi: 10.1097/BRS.0b013e3181f49718.
Retrospective multicenter study.
To review the clinical characteristics of traumatic cervical spinal cord injury (SCI) associated with ossification of the posterior longitudinal ligament (OPLL).
Despite its potentially devastating consequences, there is a lack of information about acute cervical SCI complicated by OPLL.
This study included consecutive patients with acute traumatic cervical SCI (Frankel A, B, and C) who were admitted within 48 hours of injury to 34 spine institutions across Japan. For analysis of neurologic outcome, patients who had completed at least a 6-month follow-up were included. Neurologic improvement was defined as at least one grade conversion in Frankel grade.
A total of 453 patients were identified (367 men, 86 women; mean age, 59 years). OPLL was found in 106 (23%) patients (87 men, 19 women; mean age, 66 years). Most of the patients with OPLL (94 of 106) were without bone injury, presenting with incomplete SCI. The prevalence of OPLL reached 34% in SCI without bone injury. The cause of SCI was predominantly falls (74%). Only 25% of the patients were aware of OPLL. Half of the OPLL patients reported gait disturbance before injury. Forty-eight (52%) OPLL patients without bone injury underwent surgery (median, 13.5 days after injury), mostly laminoplasty. Overall, no significant difference was noted in neurologic improvement between surgery group and conservative group. However, further stratification showed that surgery was associated with greater neurologic recovery in patients who had gait disturbance before injury (P = 0.04).
Prevalence of OPLL among cervical SCI was alarmingly high, especially in those without bone injury. Most of cervical SCI associated with OPLL were incomplete, without bone injury, and caused predominantly by low-energy trauma. The majority of the patients were unaware of OPLL. Surgery produced better neurologic recovery in patients who had gait disturbance before injury.
回顾性多中心研究。
回顾外伤性颈脊髓损伤（SCI）伴后纵韧带骨化（OPLL）的临床特征。
尽管外伤性颈椎 SCI 伴 OPLL 可能会产生严重后果，但目前对此类疾病的相关信息知之甚少。
本研究纳入了在日本 34 家脊柱中心就诊的、在受伤后 48 小时内急性外伤性颈 SCI（Frankel A、B 和 C 级）的连续患者。为了分析神经功能预后，纳入了至少完成 6 个月随访的患者。神经功能改善定义为 Frankel 分级至少提高 1 级。
共确定了 453 例患者（367 例男性，86 例女性；平均年龄 59 岁）。在 106 例（23%）患者中发现了 OPLL（87 例男性，19 例女性；平均年龄 66 岁）。大多数 OPLL 患者（94 例）无骨损伤，表现为不完全性 SCI。无骨损伤的 SCI 中 OPLL 的患病率达到 34%。SCI 的病因主要是跌倒（74%）。只有 25%的患者知晓 OPLL。一半的 OPLL 患者在受伤前有步态障碍。50 例（52%）无骨损伤的 OPLL 患者接受了手术（中位数为受伤后 13.5 天），主要是椎板成形术。总体而言，手术组和保守组的神经功能改善无显著差异。然而，进一步分层显示，对于受伤前有步态障碍的患者，手术与更大的神经恢复相关（P = 0.04）。
颈椎 SCI 中 OPLL 的患病率高得惊人，尤其是在无骨损伤的患者中。大多数外伤性颈椎 SCI 伴 OPLL 为不完全性，无骨损伤，主要由低能量创伤引起。大多数患者都不知道自己有 OPLL。对于受伤前有步态障碍的患者，手术能产生更好的神经功能恢复。
