DAPK2 promotes autophagy to accelerate the progression of ossification of the posterior longitudinal ligament through the mTORC1 complex

Background:Ossification of the posterior longitudinal ligament(OPLL)is a prevalent condition in orthopedics.While death-associated protein kinase 2(DAPK2)is known to play roles in cellular apoptosis and autophagy,its specific contributions to the advancement of OPLL are not well understood.Methods:Ligament fibroblasts were harvested from patients diagnosed with OPLL.Techniques such as real-time reverse transcriptasepolymerase chain reaction(RT-qPCR)and Western blot analysis were employed to assess DAPK2 levels in both ligament tissues and cultured fibroblasts.The extent of osteogenic differentiation in these cells was evaluated using an alizarin red S(ARS)staining.Additionally,the expression of ossification markers and autophagy markers was quantified.The autophagic activity was further analyzed through LC3 immunofluorescence and transmission electron microscopy(TEM).An in vivo heterotopic bone formation assay was conducted in mice to assess the role of DAPK2 in ossification.Results:Elevated DAPK2 expression was confirmed in both OPLL patient tissues and derived fibroblasts,in contrast to non-OPLL controls.Silencing of DAPK2 significantly curtailed osteogenic differentiation and autophagy in these fibroblasts,evidenced by decreased levels of LC3,and Beclin1,and reduced autophagosome formation.Additionally,DAPK2 was found to inhibit the mechanistic target of the rapamycin complex 1(mTORC1)complex’s activity.In vivo studies demonstrated that DAPK2 facilitates ossification,and this effect could be counteracted by the mTORC1 inhibitor rapamycin.Conclusion:DAPK2 enhances autophagy and osteogenic processes in OPLL through modulation of the mTORC1 pathway.

Catheter-Assisted Interlaminar Approach for Cervical Epidural Steroid Injection in Patient with Cervical Stenosis Caused by Ossification of Posterior Longitudinal Ligament: A Case Report

We present the case of a 64-year-old man with cervical ossification of the posterior longitudinal ligament (OPLL) experiencing chronic neck pain and radiculopathy for 6 months. A catheter-assisted interlaminar Cervical Epidural Steroid Injection (CESI) was performed under fluoroscopic guidance, targeting the affected C2-C6 levels. Significant improvement was observed after this procedure, with decreased pain scores (visual analogue scale (VAS) 8 to 2) and improved mobility. This technique not only enhances the effectiveness of CESI but also reduces the likelihood of complications such as stroke or epidural hematoma and thus provides an alternative treatment option for patients with multiple stenotic levels who are unsuitable for surgery or are unresponsive to conservative therapy such as medication or physical therapy.

A Case of Acute Cauda Equina Syndrome for Combined Lumbar Ossification of the Posterior Longitudinal and Yellow Ligament

Acute cauda equina syndrome is known as a symptom of lumbar disc herniation, but to date, there have been no reports of cases caused by lumbar vertebral ligament ossification. We encountered a 61-year-old female patient with acute cauda equina syndrome associated with lumbar vertebral OPLL and OLF. The symptoms were improved by emergency laminectomy. One year after the surgery, the disturbances of gait and urination have been resolved.

Regression of intervertebral disc calcification combined with ossification of the posterior longitudinal ligament:A case report

BACKGROUND Intervertebral disc calcification(IDC)combined with ossification of the posterior longitudinal ligament(OPLL)in cervical discs is rarely reported.This case study presents a rare case of IDC combined with OPLL in the C2-C3 segment.CASE SUMMARY Here,we present a case of a 6-year-old Asian boy with severe neck pain and stiffness.Physical examination showed no neurological or other abnormalities.Digital radiography and computed tomography(CT)revealed a calcified intervertebral disc and OPLL at the C2-C3 vertebrae.The spinal canal compromise at C2-C3 was approximately 50%on magnetic resonance imaging.The final diagnosis was IDC combined with OPLL.We applied a neck brace for the patient to protect the neck.The patient's neck pain and stiffness recovered significantly within approximately 3 wk.At the 3 mo follow-up,the follow-up CT showed resolution of the ossified intervertebral disc herniation,and a small amount of calcification and slight OPLL remained at the involved segment.CONCLUSION IDC combined with OPLL is a relatively rare condition in children.However,the majority of patients could have a favorable outcome,and the ossified mass in the canal would be spontaneously resolved with conservative therapy.

Enlarged laminectomy for ossification of posterior longitudinal ligament in cervical spine

Objective To introduce surgical strategy of enlarged laminectomy (with partial facet joint dissection to expose nerve root) ,and to discuss its benefit for cervicalossification of posterior longitudinal ligament (OPLL)

The clinical features and treatment strategies of thoracic ossification of posterior longitudinal ligament

Objective To study the clinical features and surgical strategies of thoracic spinal stenosis caused by ossification of posterior longitudinal ligament(OPLL).Methods From January 2004 to March 2009,21 cases of tho-racic spinal stenosis

"Cave-in"technique: 360° circumferential decompression for thoracic spinal stenosis with ossification of posterior longitudinal ligament

Objective To investigate the surgical techniqueand efficiency of the "Cave-in" 360° circumferential decompression for thoracic spinal stenosis(TSS)with ossification of posterior longitudinal ligament(OPLL).Methods From October 2005 to

OPLL后路单开门椎管扩大成形术后C_(5)神经根麻痹的风险

目的 探讨颈椎后纵韧带骨化症(OPLL)椎管占位严重程度与后路单开门椎管扩大成形术后C_(5)神经根麻痹的关系。方法 纳入2019年12月~2021年12月该院收治的88例OPLL患者,采用单开门椎管扩大成形术治疗,术后根据是否发生C_(5)神经根麻痹分组,比较两组术前椎管占位率以及性别、年龄、手术节段等临床资料,并采用多因素分析椎管占位率、C_(5)椎间孔宽度等与C_(5)神经根麻痹的关系。结果 88例OPLL患者术后19例发生C_(5)神经根麻痹;麻痹组与非麻痹组椎管占位率、C_(5)椎间孔宽度、术后脊髓漂移距离、手术节段数、年龄差异具有统计学意义(P<0.05);组间性别、OPLL类型差异无统计学意义(P>0.05);多因素分析显示,椎管占位率、C_(5)椎间孔宽度、脊髓漂移距离是术后C_(5)神经根麻痹的危险因素(P<0.05)。结论 OPLL单开门椎管扩大成形术后C_(5)神经根麻痹发生率较高,椎管占位率、C_(5)椎间孔宽度、脊髓漂移距离是危险因素之一。

Association between two polymorphisms of the bone morphogenetic protein-2 gene with genetic susceptibility to ossification of the posterior longitudinal ligament of the cervical spine and its severity

Background Ossification of the posterior longitudinal ligament （OPLL） has a strong genetic background. Previous studies have shown that bone morphogenetic protein-2 （BMP2） and BMP2 mRNA are expressed in ossifying matrix and chondrocytes adjacent to cartilaginous areas of OPLL tissues and mesenchymal cells with fibroblastic features in the immediate vicinity of the cartilaginous areas. It is suggested that BMP2 plays different roles in the different stages of development of OPLL. However, it remains unknown which factors induce ligament cells to produce BMP2. Methods OPLL patients （n=-192） and non-OPLL controls （n=304） were studied. Radiographs of the cervical spine were analyzed for extent of OPLL. We investigated whether single nucleotide polymorphisms of exons 3（-726） T/C and 3（-583） NG in the BMP2 gene are statistically associated with genetic susceptibility to OPLL in Chinese Han subjects. Results There was no statistical difference between the occurrence of exons 3（-726） T/C and 3（-583） NG and the occurrence of OPLL in the cervical spine. However, there was a significant association between occurrence of exon 3（-726） T/C polymorphism and occurrence of OPLL in males of cases and controls in the cervical spine. In addition, no significant association was found between the exons 3（-726） T/C and 3（-583） A/G with number of ossified cervical vertebrae in OPLL patients. Conclusions Exon 3（-583） A/G polymorphism in BMP2 gene is not associated with the occurrence and the extent of OPLL in the cervical spine. Chinese Han male patients with TC and CC genotypes in exon 3（-726） T/C have genetic susceptibility to OPLL but not to more extensive OPLL in the cervical spine.

Linkage of three polymorphisms on chromosome 20p12 to ossification of the posterior longitudinal ligament of spine and its severity in Han Chinese patients

Background Ossification of the posterior longitudinal ligament （OPLL） is characterized by the replacement of ligamentous tissue with new ectopic bone formation, and has a strong genetic background. Because of the abnormal bone metabolic features and the strong genetic component, osteoporosis is a related disorder with OPLL. Three polymorphisms on chromosome 20p12 were identified associated with the risk of osteoporosis and osteoporotic fracture.The rs996544 （C/T） ＂TT＂ and rs965291 （G/A） ＂AA＂ genotypes conferred higher risks for vertebral and hip fractures. The osteoporosis haplotype is defined by two polymorphisms, rs1116867 （A） and D35548 （T）. However, it remains unknown whether these three polymorphisms predispose to an increased frequency and severity of OPLL in Han Chinese patients.Methods A total of 420 OPLL patients and 506 age- and sex-matched controls were studied. Three single nucleotide polymorphisms （SNPs）, rs996544 （C/T）, rs965291 （G/A） and rs1116867 （A/G）, were analyzed by direct sequencing.Associations between these SNPs with the occurrence and extent of OPLL were statistically evaluated.Results There was no significant association between the rs996544 （C/T） polymorphism and the prevalence of OPLL.The rs1116867 （A/G） polymorphism ＂AG＂ genotype was associated with the occurrence of OPLL. The rs1116867 （A/G） polymorphism ＂G＂ allele was associated with the occurrence of OPLL, but not with the extent of OPLL. The rs965291 （G/A） polymorphism in female patients was statistically different between cases and controls （P 〈0.05）. The rs965291 （G/A） polymorphism ＂A＂ allele was associated with the occurrence of OPLL in female patients. For the rs965291 （G/A）polymorphism, patients with the ＂A＂ allele （genotype, ＂AG＂ or ＂AA＂） showed a significantly greater number of ossified cervical vertebrae than those without the ＂A＂ allele （genotype, ＂GG＂, P 〈0.05）, particularly in female patients.Conclusions The rs1116867 （A/G） and rs965291 （G/A） polymorphisms on chromosome 20p12 are associated with the occurrence and the extent of OPLL, at least in Han Chinese subjects. Our data should advance our understanding of the molecular etiology of OPLL and may guide approaches to prevent the onset of OPLL.

Classification and management of the tandem ossification of the posterior longitudinal ligament and flaval ligament

Objective To provide appropriate guidelines for treatment of tandem ossification of the posterior longitudinal ligament （OPLL） and flaval ligament （OFL）. Data sources Published articles about OPLL and OFL were selected using Medline and Embase electronic databases. Study selection An English literature search from January 1980 to December 2006 was conducted. Because many reported cases were incorporated in OFL studies, the key words for search were OFL or OFL and OPLL. The first step revealed 93 studies of which 13 reports of tandem OPLL and OFL （tandem ossification） were selected. Results All studies were case series or case report and advocated that the primary therapy for tandem ossification should be operative. The clinical outcomes of surgery were evaluated in most reports, predominantly using the JOA scores. Gender is the only factor which has prognostic value. A higher proportion of women was found in the failure group A two- stage classification of tandem ossification was developed to relate diagnosis to outcome. Conclusions All patients with suspected ossification of the spinal ligaments should undergo routine MRI screening of the whole spine. The correlation of the classification with surgical treatments needs further studies to validate its usefulness. Chin Med J 2009; 122（2）：219-224

Clinical results and intramedullary signal changes of posterior decompression with transforaminal interbody fusion for thoracic myelopathy caused by combined ossification of the posterior longitudinal ligament and ligamentum flavum

Background Surgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament （OPLL） and ossification of the ligamentum flavum （OLF） is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion （PTTIF） may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.

A single nucleotide polymorphism in the human bone morphogenetic protein-2 gene （109T〉G） affects the Smad signaling pathway and the predisposition to ossification of the posterior longitudinal ligament of the spine

Background Although various systemic and local factors such as abnormal carbohydrate or calcium metabolism, aging, and hormonal disturbances have been suggested as causes of ossification of the posterior longitudinal ligament （OPLL）, the etiology of OPLL is not fully understood. The purpose of this study was to investigate whether bone morphogenetic protein （BMP）-2 is a candidate gene to modify the susceptibility of OPLL and the mechanism of signal transduction in ossification. Methods A total of 420 OPLL patients and 506 age- and sex-matched controls were studied. The complete coding sequence of the human BMP-2 gene was analyzed using polymerase chain reaction （PCR） and direct sequencing. All single nucleotide polymorphisms （SNPs） were detected and genotyped. BMP-2 expression vectors containing positive polymorphisms were constructed and transfected into the C3H10T1/2 cells. The expression of BMP-2 and the Smad signal pathway in positive cell clones were detected by Western blotting. The alkaline phosphatase （ALP） activity was determined using quantitative detection kits. Results The frequencies for the 109T〉G and 570A〉T polymorphisms were different between the case and control groups. The ＂TG＂ genotype in 109T〉G polymorphism is associated with the occurrence of OPLL, the frequency of the ＂G＂ allele is significantly higher in patients with OPLL than in control subjects （P 〈0.001）. The ＂AT＂ genotype in 570A〉T polymorphism is associated with the occurrence of OPLL, the frequency of the ＂T＂ allele is significantly higher in patients with OPLL than in control subjects （P=0.005）. Western blotting analysis revealed that the expression of P-Smadl/5/8 protein transfected by wild-type or mutant expression vectors were significantly higher than control groups （P 〈0.05）, but there was no statistical difference in each experimental group （P 〉0.05）. The expression of Smad4 protein transfected by wild-type or mutant expression vectors was significantly higher than control groups （P 〈0.05）. The expression of Smad4 protein transfected by pcDNA3.1-BMP2 （109G） and pcDNA3.1-BMP2 （109G, 570T） was significantly higher than the other experimental groups （P 〈0.05）. The increase in ALP activity has been detected in pcDNA3.1-BMP2 （109G） and pcDNA3.1-BMP2 （109G, 570T） transfected cells up to 4 weeks after stable transfection. Activity of ALP was （30.56±0.46） nmol.min^-1.mg^-1 protein and （29.62±0.68） nmol.min^-1.mg^-1 protein, respectively. This was statistically different compared with the other experimental groups （P 〈0.05）. Conclusions BMP-2 is the predisposing gene of OPLL. The ＂TG＂ genotype in the 109T〉G and the ＂AT＂ genotype in the 570A〉T polymorphisms are associated with the occurrence of OPLL. The 109T〉G polymorphism in exon-2 of the BMP-2 gene is positively associated with the level of Smad4 protein expression and the activity of ALP. The Smad mediated sicjnaling pathway plays an important role durincl the Datholoqical process of OPLL induced by SNPs of BMP-2 aene.

T allele at site 6007 of bone morphogenetic protein-4 gene increases genetic susceptibility to ossification of the posterior longitudinal ligament in male Chinese Han population

Background Several candidate genes of ossification of the posterior longitudinal ligament （OPLL） susceptibility have been identified, but their polymorphisms account for only a small percent of the total variance. Bone morphogenetic protein-4 （BMP4） is a potent ectopic ossification inducing factor. BMP4 protein and mRNA are present in cells from OPLL patients, but not non-OPLL controls. A single nucleotide polymorphism of 6007C〉T（rs17563） of BMP4 has been reported to affect bone density in postmenopausal women. Thus, BMP4 may function in OPLL development. Appropriately, the relationship between BMP4 polymorphisms and OPLL was investigated. Methods A case-control association study investigated the genetic etiology in 179 OPLL patients and 298 non-OPLL controls. Extent of OPLL was analyzed by radiologic examinations. Whether single nucleotide polymorphism （SNP） of -5826G〉A（rs1957860） 5＇ of the transcription start site and 6007C〉T（rs17563） in exon 4 of the BMP4 gene were statistically associated with genetic susceptibility to OPLL in Chinese Han subjects was assessed. Results A significant statistical difference in genotype of 6007C〉T polymorphism between male OPLL patients and male controls was evident, and the frequency of ＂TT＂ genotype in male OPLL patients was significantly higher than in male controls （P=0.039）. The frequency of the ＂T＂ allele was also significantly higher in male OPLL subjects than in male controls （P=0.014, OR=1.57）. A significant difference was also observed between the 6007C〉T polymorphism and the number of ossified cervical vertebrae in OPLL patients, while no statistical difference was apparent between the -5826G〉A polymorphism and OPLL occurrence. Conclusions The T allele in the 6007C〉T polymorphism may be a risk factor for male Han Chinese with ossification of the posterior longitudinal ligament in the cervical spine. Chinese Han male patients with CT and TT 6007C〉T genotypes have a genetic susceptibility to OPLL and more extensive OPLL in the cervical spine.

Circumferential decompression via the posterior approach for the surgical treatment of multilevel thoracic ossification of the posterior longitudinal ligaments： a single institution comparative study

Background The treatment strategies for multilevel thoracic ossification of the posterior longitudinal ligaments （T-OPLL） were rarely reported. The aim of this study was to investigate the clinical outcomes and complications of circumferential decompression for multilevel T-OPLL and compare two different methods in the management of the OPLL （resection or floating）. Methods Data of sequentially treated patients who received surgical treatment for thoracic spinal stenosis caused by multilevel T-OPLL from January 2005 to February 2012 were retrospectively reviewed. Based on the surgical approaches applied, the patients were divided into two groups. Group A consisted the patients who received posterior decompression and group B consisted the patients who received circumferential decompression via the posterior approach. Group B was further divided into two subgroups： subgroup 1 （the resection group） where the OPLL was completely resected and subgroup 2 （the floating group） where the OPLL was floated. Results A total of 49 patients were included in the study. Fourteen patients with single posterior decompression were included in group A and 35 patients who received circumferential decompression were included in group B. In group B, 29 patients had complete resection of the ossified posterior longitudinal ligaments, while the other six underwent a flotation procedure. The follow-up data were available in 39 patients. Mean JOA scores improved from 5.4 ± 1.8 to 7.5 ± 2.8 in group A and from 3.7 ± 1.8 to 7.9 ± 2.4 in group B. The main complications included cerebrospinal fluid （CSF） leakage and postoperative neurelogic deterioration （ND）. Twenty-three of the 25 cases with postoperative CSF leakage achieved a complete recovery at the last follow-up and 12 of the 15 cases with ND achieved some neurological improvement at the last follow-up. Conclusions Circumferential decompression via the posterior approach is an effective surgical method for thoracic spinal stenosis caused by multilevel OPLL of the thoracic spine. Patients who receive complete resection of the ossified posterior longitudinal ligaments may have better recovery rate than the ＂floating＂ group.

显微镜辅助椎间盘切除融合内固定术对局限型后纵韧带骨化症的疗效研究

目的探析局限型后纵韧带骨化症(OPLL)患者接受显微镜下椎间盘切除融合内固定术(ACDF)治疗的近期与远期疗效情况。方法回顾性选取2020年2月—2022年2月收治的局限型OPLL患者105例,按照ACDF治疗过程中是否辅助使用显微镜分为显微镜组56例和常规组49例,观察围术期指标、视觉模拟评分法(VAS)评分、健康调查评估量表(SF-36)评分、椎管最狭窄处椎管面积与脊髓前后径、颈椎活动度、椎间隙高度、关节功能[日本骨科医师协会评分(JOA)颈椎病评分及颈部障碍指数(NDI)]及并发症风险。结果显微镜组平均手术时间(141.85±18.35)min、平均住院时间(10.18±1.58)d短于常规组的(159.46±21.42)min、(12.03±1.82)d,显微镜组术中平均出血量(80.65±7.28)mL少于常规组的(103.52±10.43)mL,差异有统计学意义(P<0.05);显微镜组术后6个月VAS评分(2.82±0.53)分、SF-36评分(79.56±5.68)分优于常规组的(3.51±0.60)、(72.35±4.77)分,差异有统计学意义(P<0.05);显微镜组与常规组在术后椎管面积、脊髓前后径上比较[(138.24±24.32)mm^(2)与(123.62±18.74)mm^(2),(5.42±0.46)mm与(4.73±0.51)mm],差异有统计学意义(P<0.05);显微镜组与常规组在术后6个月颈椎活动度上比较[(25.21±3.37)°与(28.65±3.56)°],差异有统计学意义(P<0.05);显微镜组并发症发生率为5.36%,低于常规组的18.37%,差异有统计学意义(P<0.05);显微镜组与常规组JOA、NDI评分在时间、组间和交互效应上比较,差异有统计学意义(P<0.05)。结论局限型OPLL患者实施ACDF治疗过程中借助显微镜提供清晰视野,并对骨化灶采用磨钻磨除、打薄处理,能更有效地解除脊髓压迫,改善近期疼痛和关节功能状况,降低脊髓损伤等并发症风险。

颈椎前路椎体骨化物可控前移融合对后纵韧带骨化物和内植物影响的有限元分析

背景:颈椎前路椎体骨化物可控前移融合对颈椎力学的影响尚未明确,既往研究主要集中在颈椎前路椎体骨化物可控前移融合的手术技巧、中长期疗效和术后并发症等。目的:运用有限元方法分析颈椎前路椎体骨化物可控前移融合对颈椎后纵韧带骨化物和内植物生物力学的影响。方法:选择一名健康男性志愿者进行全颈椎薄层CT扫描,应用有限元分析软件构建正常全颈椎模型,与既往文献进行对比验证其有效性;随后在模型上构建累及C4、C5和C6节段的连续型颈椎后纵韧带骨化物的术前模型;以术前模型为基础,创建颈椎前路椎体骨化物可控前移融合手术三维有限元模型,约束2个模型C7椎体下表面,于C1椎体上表面施加50 N的轴向力和1.0 N·m的力矩,在屈伸、侧弯、旋转6个工况下,分析颈椎前路椎体骨化物可控前移融合对骨化物和内植物应力的影响。结果与结论:①从术前模型得出骨化物应力主要集中在C4/5节段,在前屈、后伸、左侧弯、右侧弯、左旋转、右旋转6个工况下骨化物最大应力分别为10.1,148.6,68.9,74.8,83.8和85.1 MPa;②颈椎前路椎体骨化物可控前移融合术后,骨化物应力集中分布区域未见明显改变,但该手术会改变骨化物应力大小,除在前屈位颈椎前路椎体骨化物可控前移融合模型骨化物应力较术前模型增大(+44.7%)外,在其他5个工况下,骨化物应力较术前模型明显降低,其中后伸位下降最明显(-74.1%),在左侧弯、右侧弯、左旋转、右旋转下骨化物应力分别下降62.2%,63.3%,66.4%,67.9%;③钛板、螺钉应力主要集中在头尾两端,后伸应力最大(149.5 MPa),前屈应力最小(43.3 MPa);4个椎间融合器应力主要集中在C3/4、C6/7融合器,应力主要分布在融合器的上下表面周围,后伸应力最大(30.8 MPa),前屈应力最小(11.5 MPa);内植物(钛板、螺钉和椎间融合器)应力主要集中于头尾两端,应力较大易导致头尾两端钛板、螺钉断裂和内植物下沉;④提示颈椎前路椎体骨化物可控前移融合能明显降低骨化物应力,可能有助于防止过度增生从而压迫神经,在术后需密切关注头尾两端螺钉松动、断裂或钛板移位、断裂等情况。

不同术式颈椎单开门椎管成形术治疗多节段OPLL的疗效分析

目的分析不同术式颈椎单开门椎管成形术治疗后纵韧带骨化症的临床疗效。方法回顾性分析2013年6月至2016年6月,使用传统单开门椎管成形术(传统组)、单开门椎管成形联合微型钛板内固定术(钛板组)和改良单开门椎管成形联合侧块螺钉内固定术(改良组)治疗96例多节段颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床资料。传统组患者37例,男22例,女15例,年龄34~68岁,平均54.3岁;钛板组患者27例,男15例,女12例,年龄36~65岁,平均56.2岁;改良组为多节段OPLL合并颈椎不稳患者,共32例,男19例,女13例,年龄36~69岁,平均55.7岁。记录三组患者的手术时间、出血量、并发症、术前及随访各时间点的颈椎日本骨科协会(Japanese orthopedic association,JOA)评分以及颈肩部疼痛视觉模拟评分(visual analogue scale,VAS)、术后1周及随访各时间点的颈椎椎板开门角度,将数据进行分析处理。结果三组患者均手术顺利,随访时间15~51个月。三组的手术时间、出血量差异无统计学意义(P>0.05)。术后三组的JOA评分、VAS评分均较术前改善,差异有统计学意义(P<0.01)。三组的术前及末次随访时JOA评分、神经功能改善率、VAS评分均差异无统计学意义(P>0.05)。三组术后1周的椎板开门角度差异无统计学意义(P>0.05),末次随访时传统组椎板开门角度低于钛板组、改良组(P<0.01)。传统组8例(21.6%)患者术后出现轴性症状,钛板组为3例(11.1%),改良组为4例(12.5%),传统组轴性症状发生率高于钛板组、改良组;传统组5例(13.5%)患者术后出现C5神经麻痹,钛板组3例(11.1%),改良组3例(9.4%)。结论三种颈椎单开门椎管成形术治疗多节段OPLL均能达到有效减压、提高神经功能的效果。使用单开门椎管成形联合微型钛板内固定术和改良单开门椎管成形联合侧块螺钉内固定术能较好地维持椎板开门角度,同时降低轴性症状发生率。

椎体次全切除植骨融合治疗伴间断型OPLL的脊髓型颈椎病

目的 探讨伴间断型后纵韧带骨化症（OPLL）的脊髓型颈椎病的有效治疗方法.方法 自2000年1月～2004年12月,采用椎体次全切除植骨融合术治疗85例伴间断型OPLL的脊髓型颈椎病患者.术前均行X线、MRI检查,其中47例同时做CT检查.对于骨化的后纵韧带与硬膜无明显粘连者,直接咬除骨化的后纵韧带.遇有骨化的后纵韧带与硬膜囊粘连紧密而无法分离时,不强行咬除,采用“漂浮法”以达到椎管减压,重建椎管之目的.结果 85例患者均获4～85个月（平均33个月）的随访,按JOA评分优良率87.1%,术后改善率3.6%～94.2%,平均74.1%.术前未做CT检查的38例患者中,有6例出现硬膜破裂,行CT检查的47例患者中仅2例硬膜破裂.结论 采用“漂浮法”处理伴间断型OPLL的脊髓型颈椎病治疗效果满意;术前CT检查是必需的,以制定手术计划,减少因术前估计不足所致的术中脊髓损伤及脑脊液漏等并发症.

颈椎前路椎体次全切除融合术治疗年轻型后纵韧带骨化继发脊髓型颈椎病1例并文献回顾

颈椎后纵韧带骨化症(OPLL)是指以颈椎后纵韧带异位骨化压迫脊髓、神经根而引起四肢无力、麻木、行走困难甚至瘫痪等神经症状为特点的一种颈椎退变性疾病,是导致脊髓压迫的重要原因之一。发病原因复杂、机制尚未明确。目前,尚无特效药物防止其骨化进展。对于合并脊髓型颈椎病(CSM)的患者,手术是最直接有效的方法。手术方式包括颈前路、颈后路和前后联合入路,究竟哪一种术式是最佳的治疗方法,仍存在较大争论。本文报道1例年轻型颈椎多节段OPLL继发CSM的患者,并探讨其病因、病机及手术入路的选择。患者主要表现为颈肩部疼痛伴右上肢无力,疼痛放射至右上肢,右上肢肌肉萎缩等。经最终讨论行颈椎前路椎体次全切除融合术(ACCF)治疗,术后患者恢复可,疗效满意,可为临床提供参考。