Sasada Susumu, Hiramatsu Masafumi, Kusumegi Akira, Fujimura Haruto, Oshikata Shogo, Takahashi Yuichi, Nishida Kenki, Yasuhara Takao, Date Isao
Department of Spinal Surgery, Shinkomonji Hospital, Kitakyushu, Japan.
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Neurospine. 2020 Dec;17(4):947-953. doi: 10.14245/ns.2040200.100. Epub 2020 Dec 31.
Ossification of the posterior longitudinal ligament (OPLL) is common in East Asia. Arteriovenous fistula at the craniocervical junction (CCJ-AVF), in contrast, is rare. As OPLL occurs most often in the cervical region, these 2 conditions can coexist in the cervical spinal canal of a single patient. We report a case of CCJ-AVF found after cervical laminoplasty (CLP) for OPLL. A 68-year-old man experienced progressive myelopathy due to cervical OPLL. Magnetic resonance imaging (MRI) revealed a high-intensity area inside the spinal cord. CLP was performed and his symptoms immediately improved. Three months after CLP, however, myelopathy recurred. MRI revealed an exacerbated and enlarged high-intensity area inside the cord from the medulla oblongata to the C4/5 level with a flow void around the cord. Left vertebral artery angiography revealed CCJ-AVF with ascending and descending draining veins. Direct surgery was performed to interrupt shunt flow into the draining veins. The patient's symptoms improved to a limited degree. In this case, increased pressure inside the spinal canal due to OPLL might have decreased the shunt flow of the CCJ-AVF. Thus, the venous congestion induced by CCJ-AVF might have been exacerbated after the pressure was removed by CLP. Magnetic resonance angiography screening could help detect concurrent CCJ-AVF and OPLL.
后纵韧带骨化（OPLL）在东亚地区较为常见。相比之下，颅颈交界区动静脉瘘（CCJ-AVF）则较为罕见。由于OPLL最常发生在颈椎区域，这两种情况可能在同一患者的颈椎管内同时存在。我们报告一例在因OPLL行颈椎椎板成形术（CLP）后发现的CCJ-AVF病例。一名68岁男性因颈椎OPLL出现进行性脊髓病。磁共振成像（MRI）显示脊髓内有一个高强度区域。进行了CLP，其症状立即得到改善。然而，CLP后三个月，脊髓病复发。MRI显示从延髓到C4/5水平脊髓内高强度区域加重且扩大，脊髓周围有血流空洞。左椎动脉血管造影显示CCJ-AVF伴有上下行引流静脉。进行了直接手术以中断向引流静脉的分流。患者症状有一定程度改善。在该病例中，OPLL导致的椎管内压力升高可能减少了CCJ-AVF的分流血流。因此，CLP解除压力后，CCJ-AVF引起的静脉淤血可能会加重。磁共振血管造影筛查有助于发现并发的CCJ-AVF和OPLL。
