Division of Neurosurgery, The Spine Clinic of Los Angeles, Good Samaritan Hospital, 1245 Wilshire Avenue #717, Los Angeles, CA 90017, USA.
Neurosurg Focus. 2011 Mar;30(3):E10. doi: 10.3171/2011.1.FOCUS10256.
Ossification of the posterior longitudinal ligament (OPLL) is an important cause of cervical myelopathy that results from bony ossification of the cervical or thoracic posterior longitudinal ligament (PLL). It has been estimated that nearly 25% of patients with cervical myelopathy will have features of OPLL. Patients commonly present in their mid-40s or 50s with clinical evidence of myelopathy. On MR and CT imaging, this can be seen as areas of ossification that commonly coalesce behind the cervical vertebral bodies, leading to direct ventral compression of the cord. While MR imaging will commonly demonstrate associated changes in the soft tissue, CT scanning will better define areas of ossification. This can also provide the clinician with evidence of possible dural ossification. The surgical management of OPLL remains a challenge to spine surgeons. Surgical alternatives include anterior, posterior, or circumferential decompression and/or stabilization. Anterior cervical stabilization options include cervical corpectomy or multilevel anterior cervical corpectomy and fusion, while posterior stabilization approaches include instrumented or noninstrumented fusion or laminoplasty. Each of these approaches has distinct advantages and disadvantages. While anterior approaches may provide more direct decompression and best improve myelopathy scores, there is soft-tissue morbidity associated with the anterior approach. Posterior approaches, including laminectomy and fusion and laminoplasty, may be well tolerated in older patients. However, there often is associated axial neck pain and less improvement in myelopathy scores. In this review, the authors discuss the epidemiology, imaging findings, and clinical presentation of OPLL. The authors additionally discuss the merits of the different surgical techniques in the management of this challenging disease.
后纵韧带骨化症（OPLL）是颈椎脊髓病的一个重要原因，是由于颈椎或胸椎后纵韧带（PLL）的骨化所致。据估计，近 25%的颈椎脊髓病患者将具有 OPLL 的特征。患者通常在 40 多岁或 50 多岁时出现脊髓病的临床证据。在 MRI 和 CT 成像上，这可以被看作是骨化的区域，这些区域通常在颈椎椎体后面融合，导致脊髓的直接腹侧受压。虽然 MRI 通常会显示软组织的相关变化，但 CT 扫描可以更好地定义骨化区域。这也可以为临床医生提供可能的硬脑膜骨化的证据。OPLL 的手术治疗仍然是脊柱外科医生的一个挑战。手术选择包括前路、后路或环形减压和/或稳定。前路颈椎稳定的选择包括颈椎椎体切除术或多节段前路颈椎椎体切除术和融合术，而后路稳定的方法包括器械或非器械融合或椎板成形术。这些方法各有优缺点。虽然前路方法可能提供更直接的减压，并且对脊髓病评分的改善最好，但与前路方法相关的软组织发病率较高。后路方法，包括椎板切除术和融合术以及椎板成形术，在老年患者中可能耐受良好。然而，往往与轴向颈部疼痛和脊髓病评分的改善较少相关。在这篇综述中，作者讨论了 OPLL 的流行病学、影像学发现和临床表现。作者还讨论了不同手术技术在治疗这种具有挑战性疾病方面的优点。
