Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2021 May;83(2):387-392. doi: 10.18999/nagjms.83.2.387.
A 48-year-old female patient presented with discomfort in the front of the chest. Whole spinal X-ray revealed a thoracic curve of 52°, and thoracic computed tomography (CT) myelography and magnetic resonance imaging (MRI) showed that ossification of the posterior longitudinal ligament (OPLL) on the concave side of the apex vertebra (T9) had highly compressed the spinal cord. Cervical MRI also showed that the C4-C5 intervertebral disc herniation mildly compressed the spinal nerve. In concomitant surgery, the patient underwent cervical laminoplasty, in which OPLL was removed by decompressive laminectomy and posterior correction surgery.In patients with adult spinal deformity (ASD), asymmetric mechanical stress at the apex vertebra can cause various abnormal conditions. Long-term local mechanical stress on the concave side of the apex vertebra might have affected OPLL formation in the present case. This is the first report of a surgical case for an ossification located on the concave side of the apex vertebra in a patient with ASD. Mechanical stress at the concave side of the apex vertebra was suspected to be a cause of formation of OPLL.
一位 48 岁女性患者出现前胸不适。全脊柱 X 线片显示胸椎曲度为 52°，胸椎 CT 脊髓造影和 MRI 显示顶椎（T9）凹侧后纵韧带骨化（OPLL）高度压迫脊髓。颈椎 MRI 还显示 C4-C5 椎间盘突出轻度压迫脊神经。在同期手术中，患者接受了颈椎椎板成形术，通过减压椎板切除术和后路矫正术切除了 OPLL。在成人脊柱畸形（ASD）患者中，顶椎的不对称机械应力可导致各种异常情况。顶椎凹侧的长期局部机械应力可能影响了本病例中 OPLL 的形成。这是首例 ASD 患者顶椎凹侧骨化的手术病例报告。顶椎凹侧的机械应力被怀疑是 OPLL 形成的原因。
