后纵韧带骨化症患者椎间盘退变的分析
Analysis of intervertebral disc degeneration in patients with ossification of the posterior longitudinal ligament.
作者信息
Luo Xi, Sun Kaiqiang, Zhu Jian, Wang Shunmin, Wang Yuan, Sun Jingchuan, Shi Jiangang
机构信息
Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
Department of Orthopedics, 910 Hospital, Quanzhou, China.
出版信息
Quant Imaging Med Surg. 2022 Mar;12(3):1919-1928. doi: 10.21037/qims-21-154.
BACKGROUND
As degenerative disease with nerve compression, little is known about the relationship between cervical ossification of the posterior longitudinal ligament (OPLL) and intervertebral disc degeneration (IVDD). This study investigates the effect of ossification of ligaments on IVDD in patients with cervical OPLL. We focus on the ossification-related segment in patients diagnosed with OPLL, which is characterized by ossification that crosses intervertebral space or occurs concurrently in the upper and lower vertebrae.
METHODS
A total of 92 ossification-related segments from 40 patients were involved in the study. X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) were used to evaluate the ossification thickness, disc height, cervical range of motion (ROM) of the segment, Kang's grade, and disc signal loss. We conducted correlation analysis and subgroup comparisons to analyze the type of ossification, ossification thickness, disc height, disc signal loss, ROM and Kang's grade.
RESULTS
The specific ossification thickness was negatively correlated with the disc signal loss (P<0.05). Specific ossification thickness and specific disc height were positively correlated (P<0.05). Segments were divided into the nude group (ossification not crossing the intervertebral space) and the covered group (ossification crossing the intervertebral space). The nude group presented smaller ossification thickness and disc height, and a higher grade of disc signal loss and ROM (P<0.05).
CONCLUSIONS
The formation of OPLL may be interrelated with the alleviation of IVDD at the same segment. Furthermore, IVDD is not only related to the limited ROM caused by ossification, but also the size and shape of the ossified mass. A negative correlation exists between the ossification thickness and the severity of IVDD in OPLL patients. Ossification that crosses the interverbal space is associated with lower ROM, a thicker ossified mass, and better disc signal. For patients with nude ossification-related segments, a fusion surgery to restore intervertebral stabilization deserves serious consideration.
背景
作为一种伴有神经受压的退行性疾病，关于颈椎后纵韧带骨化（OPLL）与椎间盘退变（IVDD）之间的关系知之甚少。本研究旨在探讨韧带骨化对颈椎OPLL患者IVDD的影响。我们关注被诊断为OPLL患者的骨化相关节段，其特征是骨化穿过椎间隙或同时发生于上下椎体。
方法
本研究纳入了40例患者的92个骨化相关节段。采用X线、计算机断层扫描（CT）和磁共振成像（MRI）来评估骨化厚度、椎间盘高度、节段颈椎活动度（ROM）、Kang分级以及椎间盘信号丢失情况。我们进行了相关性分析和亚组比较，以分析骨化类型、骨化厚度、椎间盘高度、椎间盘信号丢失、ROM和Kang分级。
结果
特定的骨化厚度与椎间盘信号丢失呈负相关（P<0.05）。特定的骨化厚度与特定的椎间盘高度呈正相关（P<0.05）。节段被分为裸区组（骨化未穿过椎间隙）和覆盖区组（骨化穿过椎间隙）。裸区组的骨化厚度和椎间盘高度较小，椎间盘信号丢失分级和ROM较高（P<0.05）。
结论
OPLL的形成可能与同一节段IVDD的减轻相互关联。此外，IVDD不仅与骨化导致的ROM受限有关，还与骨化块的大小和形状有关。OPLL患者的骨化厚度与IVDD的严重程度呈负相关。穿过椎间隙的骨化与较低的ROM、较厚的骨化块以及较好的椎间盘信号相关。对于裸区骨化相关节段的患者，应认真考虑进行融合手术以恢复椎间稳定性。
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