胸椎黄韧带骨化症手术治疗预后不良相关因素研究进展

The research progress of factors associated with poor prognosis in surgical treatment of thoracic ossification of the ligamentum flavum

黄韧带主要由弹性纤维和结缔组织构成,覆盖于椎管的后壁,从上椎板的一半呈叠瓦状覆盖下椎板的上半部分,它被认为是维持脊柱内在稳定性、控制椎间运动、并维持硬脊膜后部表面光滑的重要结构[1],韧带的异位骨化便是黄韧带骨化(ossification of ligament flavum,OLF)。因胸椎椎管较颈椎及腰椎更为狭小,脊髓和神经根紧贴其中,骨化的黄韧带常导致缓慢进展的脊髓神经功能损害,出现如下肢感觉和运动功能障碍,病理征阳性,反射亢进等临床症状[2]。

Ossification of ligamentum flavum(OLF)of the spine refers to the heterotopic formation of bone in the ligamentum flavum,with the thoracic spine being the most common site.It often results in severe neurological impairment of the spinal cord.Treatment for thoracic ossification of the ligamentum flavum(TOLF)includes conservative treatment and surgery.The former is less effective and most patients experience progressive worsening of symptoms until they are paralysed,while the latter is based on posterior spinal canal resection and decompression,along with a variety of minimally invasive techniques such as unilateral biportal endoscopic.However they are difficult and risky with varying postoperative outcomes and complication rates.Therefore,there has been a great deal of research into predictors of postoperative neurological recovery,including intramedullary signal changes,duration of preoperative symptoms,preoperative modified JOA(mJOA)values,morphology and location of the ossified ligamentum flavum,spine canal occupancy,combined dural ossification,surgical methods,age,comorbidities and body mass index(BMI),but controversy still exists.This article briefly describes and summarizes the risk factors associated with TOLF poor postoperative prognosis.