Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix, AZ 85013, USA.
Neurosurg Focus. 2011 Mar;30(3):E11. doi: 10.3171/2010.12.FOCUS10265.
Ossification of the posterior longitudinal ligament (OPLL) is a rare disease that results in progressive myeloradiculopathy related to pathological ossification of the ligament from unknown causes. Although it has long been considered a disease of Asian origin, this disorder is increasingly being recognized in European and North American populations. Herein the authors present demographic, radiographic, and comorbidity data from white patients with diagnosed OPLL as well as the outcomes of surgically treated patients.
Between 1999 and 2010, OPLL was diagnosed in 36 white patients at Barrow Neurological Institute. Patients were divided into 2 groups: a group of 33 patients with cervical OPLL and a group of 3 patients with thoracic or lumbar OPLL. Fifteen of these patients who had received operative treatment were analyzed separately. Imaging analysis focused on signal changes in the spinal cord, mass occupying ratio, signs of dural penetration, spinal levels involved, and subtype of OPLL. Surgical techniques included anterior cervical decompression and fusion with corpectomy, posterior laminectomy with fusion, posterior open-door laminoplasty, and anterior corpectomy combined with posterior laminectomy and fusion. Comorbidities, cigarette smoking, and previous spine surgeries were considered. Neurological function was assessed using a modified Japanese Orthopaedic Association Scale (mJOAS).
A high-intensity signal on T2-weighted MR imaging and a history of cervical spine surgery correlated with worse mJOAS scores. Furthermore, mJOAS scores decreased as the occupying rate of the OPLL mass in the spinal canal increased. On radiographic analysis, the proportion of signs of dural penetration correlated with the OPLL subtype. A high mass occupying ratio of the OPLL was directly associated with the presence of dural penetration and high-intensity signal. In the surgical group, the rate of neurological improvement associated with an anterior approach was 58% compared with 31% for a posterior laminectomy. No complications were associated with any of the 4 types of surgical procedures. In 3 cases, symptoms had worsened at the last follow-up, with only a single case of disease progression. Laminoplasty was the only technique associated with a worse clinical outcome. There were no statistical differences (p > 0.05) between the type of surgical procedure or radiographic presentation and postoperative outcome. There was also no difference between the choice of surgical procedure performed and the number of spinal levels involved with OPLL.
Ossification of the posterior longitudinal ligament can no longer be viewed as a disease of the Asian population exclusively. Since OPLL among white populations is being diagnosed more frequently, surgeons must be aware of the most appropriate surgical option. The outcomes of the various surgical treatments among the different populations with OPLL appear similar. Compared with other procedures, however, anterior decompression led to the best neurological outcomes.
骨化性后纵韧带（OPLL）是一种罕见疾病，其特征为不明原因的韧带病理性骨化导致进行性脊神经根病。尽管 OPLL 长期以来被认为是一种亚洲起源的疾病，但这种疾病在欧洲和北美人群中的发病率正在逐渐增加。在此，作者介绍了白人 OPLL 患者的人口统计学、影像学和合并症数据，以及手术治疗患者的结局。
1999 年至 2010 年，巴罗神经研究所诊断出 36 例白人 OPLL 患者。患者分为两组：33 例颈椎 OPLL 患者和 3 例胸腰椎 OPLL 患者。对其中 15 例接受手术治疗的患者进行了单独分析。影像学分析侧重于脊髓信号变化、占位率、硬脑膜穿透迹象、受累脊柱水平和 OPLL 亚型。手术技术包括前路颈椎减压融合伴椎体切除术、后路椎板切除术伴融合、后路开门椎板成形术和前路椎体切除术联合后路椎板切除术和融合术。考虑了合并症、吸烟和以前的脊柱手术。神经功能采用改良日本矫形协会量表（mJOAS）进行评估。
T2 加权磁共振成像上的高信号和颈椎手术史与 mJOAS 评分较差相关。此外，随着 OPLL 椎管内占位率的增加，mJOAS 评分降低。在影像学分析中，硬脑膜穿透迹象的比例与 OPLL 亚型相关。高 OPLL 占位率与硬脑膜穿透和高信号直接相关。在手术组中，前路治疗的神经改善率为 58%，后路椎板切除术为 31%。4 种手术类型均无并发症。在 3 例中，最后一次随访时症状恶化，仅 1 例病情进展。只有椎板成形术与更差的临床结局相关。手术类型或影像学表现与术后结局之间无统计学差异（p > 0.05）。OPLL 涉及的手术脊柱水平数量与手术方式之间也无差异。
OPLL 不能再被视为亚洲人群特有的疾病。由于白人人群中 OPLL 的诊断率越来越高，外科医生必须了解最合适的手术选择。不同人群 OPLL 的各种手术治疗结果似乎相似。然而，与其他手术相比，前路减压可获得最佳的神经学结局。
