Spitzer Daniel
Assistant Clinical Professor of Neurosurgery, Columbia College of Physicians and Surgeons, New York, USA ; Chief Section of Neurosurgery, Nyack Hospital, Nyack, NY, USA.
Surg Neurol Int. 2014 Aug 28;5(Suppl 7):S365-7. doi: 10.4103/2152-7806.139670. eCollection 2014.
A previously healthy and asymptomatic male surviving well into his ninth decade (86 years of age) was rendered immediately and completely quadriplegic after a minor fall associated with cervical hyperextension.
Since he was unable to undergo a magnetic resonance (MR) scan due to the presence of a cardiac pacemaker, a non-contrast computed tomography (CT) was performed. This study demonstrated extremely severe cervical spinal canal stenosis secondary to previously undiagnosed ossification of the posterior longitudinal ligament (OPLL) resulting in marked spinal cord compression between C5 and C6.
Secondary to his severe and irreversible quadriplegia, the patient elected not to undergo any intervention; he expired 4 days later. Had his deficit not been so severe, and had he been diagnosed earlier and undergone prophylactic/preventive posterior decompression (e.g. laminectomy C4-C7) sufficient to allow his cord to migrate dorsally, his irreversible quadriplegic deficit might have been avoided.
Older patients with symptoms of progressive myelopathy should undergo early cervical MR (or CT if they have a pacemaker) screening looking for "silent" cord compression due to stenosis, spondyloarthrosis, and/or OPLL. This case highlights the devastating consequences of even a mild hyperextension injury in a patient harboring extremely severe but previously undiagnosed OPLL. Devastating life-threatening or life-ending injuries may be avoided by maintaining a low threshold for performing screening" cervical studies in elderly patients with vague complaints that might signal the onset of myelopathy.
一名既往健康且无症状的男性，活到了九十多岁（86岁），在一次与颈椎过伸相关的轻微跌倒后立即完全四肢瘫痪。
由于他有心脏起搏器，无法进行磁共振（MR）扫描，因此进行了非增强计算机断层扫描（CT）。这项研究显示，继发于先前未诊断出的后纵韧带骨化（OPLL）的极其严重的颈椎管狭窄，导致C5和C6之间脊髓明显受压。
由于严重且不可逆的四肢瘫痪，患者选择不接受任何干预；4天后死亡。如果他的神经功能缺损没有那么严重，如果能更早诊断并进行预防性/预防性后路减压（如C4 - C7椎板切除术），使脊髓能够背侧移位，他不可逆的四肢瘫痪缺损或许可以避免。
有进行性脊髓病症状的老年患者应尽早进行颈椎MR（如果有起搏器则进行CT）筛查，以寻找因狭窄、脊椎关节病和/或OPLL导致的“隐匿性”脊髓受压。该病例突出了在患有极其严重但先前未诊断出的OPLL的患者中，即使是轻度过伸损伤也会带来毁灭性后果。对于有可能预示脊髓病发作的模糊症状的老年患者，保持较低的阈值进行筛查性“颈椎检查”，可以避免危及生命或导致生命终结的毁灭性损伤。
