Peking University Third Hospital, Department of Orthopaedics, Beijing, 100191, People's Republic of China.
Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, People's Republic of China.
Clin Interv Aging. 2021 May 24;16:897-908. doi: 10.2147/CIA.S313357. eCollection 2021.
Cervical ossification of ligamentum flavum (COLF) is a rare clinical entity which can occasionally contribute to severe myeloradiculopathy. Many orthopedists are unfamiliar with or underestimate this pathology. Therefore, a comprehensive research is obligatory to reappraise the epidemiological, radiological, clinical and histopathological characteristics of COLF-myeloradiculopathy based on synthesis of individual patient data.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, EMBASE, Scopus and Web of Science databases were searched for studies discussing COLF-myeloradiculopathy from the inception to December 2020.
A total of 94 cases from 54 studies were identified. The annual publications demonstrated a steady increase, and most reports were from Japan and China. The mean age was 58.76±13.39 years and nearly 60% of cases occurred in the 55-64 and 65-74 years age group. The male-female ratio was 1.4:1. Most cases belonged to East Asian population (60.64%). COLF predominately appeared in the lower cervical and cervicothoracic spine (76.60%) and mainly affected C4-5 (23.29%) and C5-6 (21.23%). Single-segment type ossification accounted for 62.76 and 45.45% of ossification lesions distributed bilaterally. The majority of COLF (81.1%) were spontaneous, and motor disturbance (76.4%), spinal ataxia (62.5%) and sensory disturbance (58.9%) were the most common manifestations. Histopathologically, it's a metaplastic process of endochondral ossification with the formation of mature lamellar bone which was distinguished from calcification of ligamentum flavum. About 21.28% of concurrent COLF and COPLL cases were identified as a separated group, with unique characteristics.
COLF is an underappreciated but potentially growing pathogeny of myeloradiculopathy in aging population, though its distinct epidemiological, radiological, clinical and histopathological features are not fully supported by current evidence. However, our findings will provide several referential data for future researches to shed light on COLF.
颈椎黄韧带骨化（COLF）是一种罕见的临床实体，偶尔会导致严重的脊神经根病。许多骨科医生对这种病理不熟悉或低估了它。因此，有必要基于个体患者数据的综合研究，重新评估 COLF-脊神经根病的流行病学、影像学、临床和组织病理学特征。
根据系统评价和荟萃分析的首选报告项目，从成立到 2020 年 12 月，在 PubMed、EMBASE、Scopus 和 Web of Science 数据库中搜索讨论 COLF-脊神经根病的研究。
从 54 项研究中确定了 94 例病例。年度出版物显示出稳步增加的趋势，大多数报告来自日本和中国。平均年龄为 58.76±13.39 岁，近 60%的病例发生在 55-64 岁和 65-74 岁年龄组。男女比例为 1.4:1。大多数病例属于东亚人群（60.64%）。COLF 主要出现在下颈椎和颈胸段（76.60%），主要影响 C4-5（23.29%）和 C5-6（21.23%）。单节段型骨化占骨化病变双侧分布的 62.76%和 45.45%。大多数 COLF（81.1%）为自发性，运动障碍（76.4%）、脊髓共济失调（62.5%）和感觉障碍（58.9%）是最常见的表现。组织病理学上，它是一种软骨内成骨的化生过程，形成成熟的板层骨，与黄韧带钙化不同。约 21.28%的并发 COLF 和 COPLL 病例被确定为一个独立的组别，具有独特的特征。
COLF 是一种被低估但潜在的、与老龄化人群脊神经根病有关的日益增多的病因，但目前的证据并没有充分支持其独特的流行病学、影像学、临床和组织病理学特征。然而，我们的研究结果将为未来的研究提供一些参考数据，以阐明 COLF。
