重度后纵韧带骨化症患者脊柱骨化病变的分布及基于颈椎OP指数分类的各节段骨化预测：一项多中心研究（JOSL CT研究）
Distribution of ossified spinal lesions in patients with severe ossification of the posterior longitudinal ligament and prediction of ossification at each segment based on the cervical OP index classification: a multicenter study (JOSL CT study).
作者信息
Hirai Takashi, Yoshii Toshitaka, Nagoshi Narihito, Takeuchi Kazuhiro, Mori Kanji, Ushio Shuta, Iwanami Akio, Yamada Tsuyoshi, Seki Shoji, Tsuji Takashi, Fujiyoshi Kanehiro, Furukawa Mitsuru, Nishimura Soraya, Wada Kanichiro, Furuya Takeo, Matsuyama Yukihiro, Hasegawa Tomohiko, Takeshita Katsushi, Kimura Atsushi, Abematsu Masahiko, Haro Hirotaka, Ohba Tetsuro, Watanabe Masahiko, Katoh Hiroyuki, Watanabe Kei, Ozawa Hiroshi, Kanno Haruo, Imagama Shiro, Ando Kei, Fujibayashi Shunsuke, Koda Masao, Yamazaki Masashi, Matsumoto Morio, Nakamura Masaya, Okawa Atsushi, Kawaguchi Yoshiharu
机构信息
Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
出版信息
BMC Musculoskelet Disord. 2018 Apr 5;19(1):107. doi: 10.1186/s12891-018-2009-7.
BACKGROUND
In patients with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine, it is well known that the thoracic ossified lesions often coexist with the cervical lesions and can cause severe myelopathy. However, the prevalence of OPLL at each level of the thoracic and lumbar spinal segments is unknown. The aims of this study were to investigate how often OPLL occurs at each level in the thoracolumbar spine in patients with a radiological diagnosis of cervical OPLL and to identify the spinal levels most likely to develop ossification.
METHODS
Data were collected from 20 institutions in Japan. Three hundred and twenty-two patients with a diagnosis of cervical OPLL were included. The OPLL index (OP index), defined as the sum of the vertebral body and intervertebral disc levels where OPLL is present, was used to determine disease severity. An OP index ≥20 was defined as severe OPLL. The prevalence of OPLL at each level of the thoracic and lumbar spinal segments was calculated.
RESULTS
Women were more likely to have ossified lesions in the thoracolumbar spine than men. Severe OPLL was significantly more common in women than in men (20% vs. 4.5%). For thoracic vertebral OPLL, the most frequently affected was the T1 segment in both men and women, followed by the T1/2 and T3/4 intervertebral levels in men and women, respectively. Ossified lesions were frequently seen at the intervertebral and vertebral levels around the cervicothoracic and thoracolumbar junctions in men with severe OPLL, whereas OPLL was more diffusely distributed in the thoracic spine in women with severe OPLL.
CONCLUSION
Thoracolumbar OPLL occurred most often at T1 in men and at T3/4 in women. In severe OPLL cases, although ossified lesions were frequently seen at the intervertebral and vertebral levels around the cervicothoracic and thoracolumbar junctions in men, OPLL could be observed more diffusely in the thoracic spine in women.
背景
在颈椎后纵韧带骨化（OPLL）患者中，众所周知，胸椎骨化病变常与颈椎病变共存，并可导致严重的脊髓病。然而，胸腰椎各节段OPLL的患病率尚不清楚。本研究的目的是调查经影像学诊断为颈椎OPLL的患者胸腰椎各节段OPLL的发生频率，并确定最易发生骨化的脊柱节段。
方法
数据收集自日本的20家机构。纳入322例诊断为颈椎OPLL的患者。OPLL指数（OP指数）定义为存在OPLL的椎体和椎间盘节段之和，用于确定疾病严重程度。OP指数≥20被定义为严重OPLL。计算胸腰椎各节段OPLL的患病率。
结果
女性胸腰椎骨化病变的发生率高于男性。严重OPLL在女性中明显比男性更常见（20%对4.5%）。对于胸椎OPLL，男性和女性最常受累的是T1节段，男性其次是T1/2节段，女性其次是T3/4椎间盘节段。严重OPLL男性患者在颈胸和胸腰交界处周围的椎间盘和椎体节段经常出现骨化病变，而严重OPLL女性患者的OPLL在胸椎中分布更广泛。
结论
胸腰椎OPLL在男性中最常发生于T1节段，在女性中最常发生于T3/4节段。在严重OPLL病例中，虽然男性在颈胸和胸腰交界处周围的椎间盘和椎体节段经常出现骨化病变，但女性的OPLL在胸椎中分布更广泛。
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