Hongo Michio, Miyakoshi Naohisa, Fujii Masashi, Kasukawa Yuji, Ishikawa Yoshinori, Kudo Daisuke, Shimada Yoichi
Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
Case Rep Orthop. 2018 Feb 18;2018:9076509. doi: 10.1155/2018/9076509. eCollection 2018.
Symptomatic ossification of the anterior longitudinal ligament (OALL) is rare. However, when the osteophyte enlarges and obstructive symptoms occur, the patient may require surgery. We present a case of pyogenic spondylitis caused by methicillin-resistant associated with tracheostomy followed by resection of OALL. A 69-year-old woman with OALL complained of dysphagia and suffocation, which was caused by prominent OALL at C4-5. Tracheostomy was performed, followed by osteophytectomy 6 weeks later. Two months after osteophytectomy, she complained of muscle weakness of the extremities, neck pain, and elevated temperature. Magnetic resonance imaging showed an intensity change at the C4-5 vertebrae and an epidural abscess that was causing cord compression requiring urgent decompression. Cultures identified methicillin-resistant . As osteolytic change and muscle weakness gradually progressed, she underwent anterior and posterior reconstruction with an autograft and instrumentation. Bone union was confirmed at 1 year postoperatively with improvement in neurological status. OALL has potentially the risk of airway obstruction. Therefore, appropriate diagnosis and prompt osteophytectomy are needed in cases of a large prominent ossification that puts the patient at risk of suffocation. However, it is noted that osteophytectomy following urgent tracheostomy carries the possible risk of infection.
症状性前纵韧带骨化（OALL）较为罕见。然而，当骨赘增大并出现梗阻症状时，患者可能需要手术治疗。我们报告一例由耐甲氧西林菌引起的化脓性脊柱炎病例，该病例伴有气管切开术，随后进行了OALL切除术。一名患有OALL的69岁女性因C4 - 5水平明显的OALL出现吞咽困难和窒息症状。先进行了气管切开术，6周后进行了骨赘切除术。骨赘切除术后两个月，她出现四肢肌无力、颈部疼痛和体温升高。磁共振成像显示C4 - 5椎体有信号改变以及一个硬膜外脓肿导致脊髓受压，需要紧急减压。培养结果确定为耐甲氧西林菌。随着骨质溶解改变和肌无力逐渐进展，她接受了自体骨移植和内固定的前后路重建手术。术后1年确认骨愈合，神经功能状态有所改善。OALL有潜在的气道梗阻风险。因此，对于有导致患者窒息风险的大的明显骨化病例，需要进行恰当诊断并及时行骨赘切除术。然而，需要注意的是，紧急气管切开术后行骨赘切除术存在感染的可能风险。
