Hirai Takashi, Yoshii Toshitaka, Hashimoto Jun, Ushio Shuta, Mori Kanji, Maki Satoshi, Katsumi Keiichi, Nagoshi Narihito, Takeuchi Kazuhiro, Furuya Takeo, Watanabe Kei, Nishida Norihiro, Nishimura Soraya, Watanabe Kota, Kaito Takashi, Kato Satoshi, Nagashima Katsuya, Koda Masao, Nakashima Hiroaki, Imagama Shiro, Murata Kazuma, Matsuoka Yuji, Wada Kanichiro, Kimura Atsushi, Ohba Tetsuro, Katoh Hiroyuki, Watanabe Masahiko, Matsuyama Yukihiro, Ozawa Hiroshi, Haro Hirotaka, Takeshita Katsushi, Matsumoto Morio, Nakamura Masaya, Egawa Satoru, Matsukura Yu, Inose Hiroyuki, Okawa Atsushi, Yamazaki Masashi, Kawaguchi Yoshiharu
Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo 113-8519, Japan.
Department of Orthopaedic Surgery, Shiga University of Medical Science, Ōtsu 520-2192, Japan.
J Clin Med. 2022 Jun 27;11(13):3694. doi: 10.3390/jcm11133694.
The purpose of this study was to clarify the clinical features of ossification of the posterior longitudinal ligament (OPLL) and extreme ossification at multiple sites.
This prospective study involved patients with a diagnosis of cervical OPLL at 16 institutions in Japan. Patient-reported outcome measures, including responses on the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ), JOA Back Pain Evaluation Questionnaire (JOA-BPEQ), and visual analog scale pain score, were collected to investigate clinical status. In each patient, the sum of the levels at which OPLL was located (OP index) was evaluated on whole-spine computed tomography, along with ossification of other spinal ligaments including the anterior longitudinal ligament (OALL), ligament flavum (OLF), supra- and intraspinous ligaments (SSL), and diffuse idiopathic skeletal hyperostosis (DISH). The distribution of OP index values in the study population was investigated, and the clinical and radiologic characteristics of patients in the top 10% were assessed.
In total, 236 patients (163 male, 73 female; mean age 63.5 years) were enrolled. Twenty-five patients with OP index ≥ 17 were categorized into a high OP index group and the remainder into a moderate/low OP index group. There were significantly more women in the high OP index group. Patients in the high OP index group also had significantly poorer scores for lower extremity function and quality of life on the JOA-CMEQ and in each domain but not for body pain on the JOA-BPEQ compared with those in the moderate/low OP index group. Patients in the high OP index group had more OALL in the cervical spine and more OLF and SSL in the thoracic spine. The prevalence of DISH was also significantly higher in the high OP index group. In the high OP index group, interestingly, OPLL was likely to be present adjacent to DISH in the cervicothoracic and thoracolumbar spine, especially in men, and often coexisted with DISH in the thoracic spine in women.
This prospective cohort registry study is the first to demonstrate the clinical and radiologic features of patients with OPLL and a high OP index. In this study, patients with a high OP index had poorer physical function in the lumbar spine and lower extremities and were also predisposed to extreme ossification of spinal ligaments other than the OPLL.
本研究旨在阐明后纵韧带骨化（OPLL）及多部位极端骨化的临床特征。
这项前瞻性研究纳入了日本16家机构中诊断为颈椎OPLL的患者。收集患者报告的结局指标，包括日本骨科协会（JOA）颈椎病评估问卷（JOA - CMEQ）、JOA背痛评估问卷（JOA - BPEQ）的回答以及视觉模拟量表疼痛评分，以调查临床状况。对每位患者，在全脊柱计算机断层扫描上评估OPLL所在节段的总和（OP指数），以及其他脊柱韧带的骨化情况，包括前纵韧带（OALL）、黄韧带（OLF）、棘上和棘间韧带（SSL）以及弥漫性特发性骨肥厚（DISH）。研究了研究人群中OP指数值的分布，并评估了OP指数最高的10%患者的临床和放射学特征。
总共纳入了236例患者（男性163例，女性73例；平均年龄63.5岁）。OP指数≥17的25例患者被归入高OP指数组，其余患者归入中/低OP指数组。高OP指数组中的女性明显更多。与中/低OP指数组相比，高OP指数组患者在JOA - CMEQ上的下肢功能和生活质量得分以及各领域得分明显更差，但在JOA - BPEQ上的身体疼痛得分并非如此。高OP指数组患者颈椎的OALL更多，胸椎的OLF和SSL更多。高OP指数组中DISH的患病率也明显更高。有趣的是，在高OP指数组中，OPLL在颈胸段和胸腰段脊柱中可能与DISH相邻存在，尤其是在男性中，而在女性中OPLL在胸椎中常与DISH共存。
这项前瞻性队列登记研究首次展示了OPLL和高OP指数患者的临床和放射学特征。在本研究中，高OP指数患者的腰椎和下肢身体功能较差，并且还易发生除OPLL之外的脊柱韧带极端骨化。
