项韧带骨化与后纵韧带骨化症患者全脊柱骨化严重程度的相关性——一项多中心CT研究

Co-existence of ossification of the nuchal ligament is associated with severity of ossification in the whole spine in patients with cervical ossification of the posterior longitudinal ligament -A multi-center CT study.

作者信息

Yoshii Toshitaka, Hirai Takashi, Iwanami Akio, Nagoshi Narihito, Takeuchi Kazuhiro, Mori Kanji, Yamada Tsuyoshi, Seki Shoji, Tsuji Takashi, Fujiyoshi Kanehiro, Furukawa Mitsuru, Nishimura Soraya, Wada Kanichiro, Koda Masao, 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, Matsumoto Morio, Nakamura Masaya, Yamazaki Masashi, Okawa Atsushi, Kawaguchi Yoshiharu

机构信息

Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan; Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan.

出版信息

J Orthop Sci. 2019 Jan;24(1):35-41. doi: 10.1016/j.jos.2018.08.009. Epub 2018 Sep 20.

DOI:10.1016/j.jos.2018.08.009

PMID:30243519

Abstract

BACKGROUND

Previous studies have shown that patients with cervical ossification of the posterior longitudinal ligament (OPLL) often have co-existing ossification of the nuchal ligament (ONL). However, no studies have focused on ONL and its relevance to the severity of OPLL or ossification of other spinal ligaments, such as anterior longitudinal ligament (OALL), ligamentum flavum (OLF), and supraspinous/interspinous ligament (OSIL).

METHODS

In this multicenter study, we investigated ossification of the spinal ligaments in the whole spine computed tomography (CT) images of 233 cervical OPLL patients. The severity of ossification was evaluated using ossification index for each spinal ligament, calculated as the sum of the level of ossification. We compared the severity of ossification in each spinal ligament between patients with ONL and those without ONL. Furthermore, we investigated how the number of segments, where ONL exists, affects the severity of ossification in each spinal ligament.

RESULTS

One hundred thirty patients (55.8%) had co-existing ONL in the cervical OPLL patients included in this study. The ONL (+) group included more male and aged patients. The cervical ossification indexes of OPLL and OALL were higher in ONL (+) patients than in ONL (-) patients. The thoracolumbar ossification indexes of OALL and OSIL were also higher in ONL (+) patients. Logistic regression analysis revealed that age, gender and cervical OA-index were independent factors correlating to the existence of ONL. In the cervical spine, both the ossification indexes of OALL and OPLL increased as the levels of ONL increased. Similarly, in the thoracolumbar spine, both the ossification indexes of OALL and OSIL were increased as the levels of cervical ONL increased. In the multiple regression analysis, cervical OA-index and thoracolumbar OSI-index showed significant correlation with the number of ONL levels.

CONCLUSIONS

Co-existence of ONL in cervical OPLL patients was associated with the severity of spinal hyperostosis especially in cervical OPLL, OALL, thoracolumbar OALL and OSIL.

摘要

背景

既往研究表明，颈椎后纵韧带骨化（OPLL）患者常并存项韧带骨化（ONL）。然而，尚无研究关注ONL及其与OPLL严重程度或其他脊柱韧带骨化的相关性，如前纵韧带骨化（OALL）、黄韧带骨化（OLF）和棘上/棘间韧带骨化（OSIL）。

方法

在这项多中心研究中，我们在233例颈椎OPLL患者的全脊柱计算机断层扫描（CT）图像中调查了脊柱韧带的骨化情况。使用每个脊柱韧带的骨化指数评估骨化严重程度，骨化指数计算为骨化节段数之和。我们比较了有ONL和无ONL患者各脊柱韧带的骨化严重程度。此外，我们研究了存在ONL的节段数量如何影响各脊柱韧带的骨化严重程度。

结果

本研究纳入的颈椎OPLL患者中，130例（55.8%）并存ONL。ONL（+）组男性和老年患者更多。ONL（+）患者的颈椎OPLL和OALL骨化指数高于ONL（-）患者。ONL（+）患者的胸腰椎OALL和OSIL骨化指数也更高。逻辑回归分析显示，年龄、性别和颈椎骨关节炎指数是与ONL存在相关的独立因素。在颈椎，OALL和OPLL的骨化指数均随ONL节段数增加而升高。同样，在胸腰椎，OALL和OSIL的骨化指数均随颈椎ONL节段数增加而升高。在多元回归分析中，颈椎骨关节炎指数和胸腰椎骨化指数与ONL节段数呈显著相关。