Yasui T
No Shinkei Geka. 1984 Aug;12(9):1021-7.
In this paper the author reported an operative approach for ossification of the posterior longitudinal ligament (OPLL) of the lower cervical and upper thoracic vertebrae. There are two types of surgery for OPLL, namely, posterior and anterior approaches. As a rule, we utilize an anterior approach for OPLL. Recently we performed a modified sternum-splitting approach in surgery for OPLL in the cervico-thoracic junction. In the original trans-sternal approach introduced by Cauchoix, the sternum is split from the suprasternal notch to the xiphoid process. We cut the manubrium only. However, a satisfactory exposure of the cervico-thoracic vertebrae down to the third thoracic level was obtained. After reaching the anterior surface of the cervico-thoracic vertebrae, the central portion of the vertebral body and the ossified lesion between the lower one third of the C7 vertebral body and the upper one third of the Th3 vertebral body were removed with an air-drill under an operating microscope. The longitudinal bone defect of the vertebral bodies was filled with a bone graft obtained from the iliac bone. Removal of the ossified lesion in the cervico-thoracic junction can be performed safely by utilizing the modified sternum-splitting approach. This approach can be applied also to endarterectomies at the origins of the vertebral arteries and the right subclavian artery.
本文作者报告了一种下颈椎和上胸椎后纵韧带骨化症（OPLL）的手术入路。OPLL有两种手术方式，即后路和前路。通常，我们对OPLL采用前路手术。最近，我们在颈胸交界处OPLL手术中采用了改良胸骨劈开入路。在Cauchoix介绍的原始经胸骨入路中，胸骨从胸骨上切迹劈开至剑突。我们仅切开胸骨柄。然而，获得了对颈胸椎直至第三胸椎水平的满意显露。到达颈胸椎前表面后，在手术显微镜下用气动钻切除椎体中央部分以及C7椎体下三分之一与Th3椎体上三分之一之间的骨化病变。椎体的纵向骨缺损用取自髂骨的骨移植填充。利用改良胸骨劈开入路可安全地切除颈胸交界处的骨化病变。该入路也可应用于椎动脉和右锁骨下动脉起始处的动脉内膜切除术。
