骨化的前纵韧带影响无影像学异常的脊髓损伤后神经功能缺损的严重程度和分布。

Ossification of the anterior longitudinal ligament affects the severity and distribution of neurological deficits following spinal cord injury without radiological abnormality.

机构信息

Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.

出版信息

J Orthop Sci. 2024 May;29(3):718-725. doi: 10.1016/j.jos.2023.03.006. Epub 2023 Mar 22.

DOI:10.1016/j.jos.2023.03.006

PMID:36964115

Abstract

BACKGROUND

The incidence of spinal cord injury without radiological abnormality (SCIWORA) is increasing among older adults in developed countries. SCIWORA is commonly associated with ossification of the spinal ligament, specifically the ossification of the posterior longitudinal ligament (OPLL) and ossification of the anterior longitudinal ligament (OALL). OALL induces segmental spinal fusion and alters the biomechanical properties of the cervical spine; however, whether OALL modulates the severity of SCIWORA remains unknown. This study aimed to investigate the influence of OALL on the severity and distribution of neurological deficits following SCIWORA.

METHODS

This retrospective study included 122 patients with SCIWORA who were admitted to our hospital from April 2008 to March 2022. The neurological function of all the included patients was assessed via the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at admission. Magnetic resonance imaging (MRI) and computed tomography were performed within 48 h of trauma. Central cord syndrome (CCS) was defined as the upper-extremity ASIA motor score being at least 10 points lesser than the lower-extremity motor score.

RESULTS

The study included 122 patients with a mean age of 65.1 years. Comparing mild (AIS grades C or D) and severe (AIS grades A or B) neurological deficits revealed that the former was independently associated with ground-level falls, OALL, and absence of prevertebral T2 high-intensity area on MRI. Although 39% of patients with SCIWORA exhibited OPLL as an etiology of cervical stenosis, OPLL demonstrated no significant effect on the severity of neurological deficits. CCS occurrence was independently associated with OALL and a larger cross-sectional cord area on MRI. Patients with OALL had significantly higher lower-extremity ASIA motor scores than those without OALL.

CONCLUSIONS

OALL was significantly associated with mild neurological deficits in the lower extremities and with the occurrence of CCS after SCIWORA.

摘要

背景

在发达国家，老年人的无放射学异常的脊髓损伤（SCIWORA）发病率正在上升。SCIWORA 通常与脊柱韧带骨化有关，特别是后纵韧带（OPLL）和前纵韧带（OALL）骨化。OALL 引起节段性脊柱融合并改变颈椎的生物力学特性；然而，OALL 是否调节 SCIWORA 的严重程度尚不清楚。本研究旨在探讨 OALL 对 SCIWORA 后神经功能缺损严重程度和分布的影响。

方法

本回顾性研究纳入了 2008 年 4 月至 2022 年 3 月期间我院收治的 122 例 SCIWORA 患者。所有纳入患者入院时均通过美国脊髓损伤协会（ASIA）损伤量表（AIS）进行神经功能评估。创伤后 48 小时内进行磁共振成像（MRI）和计算机断层扫描。中央脊髓综合征（CCS）定义为上肢 ASIA 运动评分比下肢运动评分至少低 10 分。

结果

本研究共纳入 122 例患者，平均年龄为 65.1 岁。比较轻度（AIS 分级 C 或 D）和重度（AIS 分级 A 或 B）神经功能缺损发现，前者与地面水平跌倒、OALL 以及 MRI 上无椎体前 T2 高信号区有关。尽管 39%的 SCIWORA 患者存在颈椎狭窄的 OPLL 病因，但 OPLL 对神经功能缺损的严重程度无显著影响。CCS 的发生与 OALL 和 MRI 上更大的脊髓横截面积有关。有 OALL 的患者下肢 ASIA 运动评分明显高于无 OALL 的患者。