Isu T, Iwasaki Y, Miyasaka K, Abe H, Tashiro K, Ito T
Neuroradiology. 1986;28(3):215-20. doi: 10.1007/BF00548195.
Herniated nuclear material of the cervical disc often perforates the posterior longitudinal ligament. Of 22 patients who were operated on by an anterior approach, 10 were of this type (the subligamentous type of cervical disc protrusion), while in the remaining 12 patients and 15 discs the protruded disc caused no tear in the ligament (the epiligamentous type). Myelography and CT myelography of these patients were reviewed. On CT myelography a localized and sharply demarcated excavation of the metrizamide ring was commonly found in the subligamentous type. Myelographic lateral view in this group shows a moderate or large indentation of the metrizamide column, since the herniated nucleus pulposus sometimes migrates caudally or cephalically. A small myelographic deformity coupled with diffuse excavation of the metrizamide ring on a CT myelogram leads us to the diagnosis of the epiligamentous type of cervical disc protrusion. In such cases, excision of the ligament is unnecessary during exploration of the discs, except when there is marked depression in the posterior longitudinal ligament. Presurgical recognition of both anatomical processes must be stressed for anterior discectomy.
颈椎间盘的髓核突出常穿破后纵韧带。在22例接受前路手术的患者中，10例为此种类型（颈椎间盘突出的韧带下型），而其余12例患者及15个椎间盘的突出椎间盘未造成韧带撕裂（韧带外型）。回顾了这些患者的脊髓造影和CT脊髓造影检查结果。在CT脊髓造影中，韧带下型通常可见甲泛葡胺环的局限性、边界清晰的缺损。该组脊髓造影侧位片显示甲泛葡胺柱有中度或较大压迹，因为突出的髓核有时会向尾侧或头侧移位。脊髓造影有小的畸形，同时CT脊髓造影显示甲泛葡胺环弥漫性缺损，提示我们诊断为颈椎间盘突出的韧带外型。在这种情况下，除非后纵韧带明显凹陷，否则在椎间盘探查时无需切除韧带。对于前路椎间盘切除术，必须强调术前对这两种解剖过程的识别。
