最新OPLL颈椎后纵韧带骨化课件ppt

Natural History
➢ Patients with OPLL commonly present in their fifth and sixth decades,with men affected twice as often as women.
➢ Most patients have some neurologic symptoms at diagnosis, with 28% to 39% fulfilling diagnostic criteria for myelopathy
➢OPLL was first described in Japanese patients and has classically been considered a cause of myelopathy in patients of East Asian origin
➢spondylosis来自百度文库➢myelopathy ➢radiculopathy ➢stenosis ➢disc herniation
OPLL颈椎后纵韧带骨化
➢Ossification of the posterior longitudinal ligament (OPLL) results from pathologic replacement of the PLL with lamellar bone, potentially causing spinal cord compression and neurologic deterioration
➢ Risk factors for the development of myelopathy include ＞60% spinal canal stenosis,＜6 mm of space available for the cord, increased cervical range of motion, and OPLL that is laterally deviated within the spinal canal
➢ Up to 50% of Caucasian patients with OPLL also have diffuse idiopathic skeletal hyperostosis
➢ Hypoparathyroidism,hypophosphatemic rickets,hyperinsulinemia, and obesity have been identified as risk factors
➢ functionally,the PLL resists spine hyperflexion
Pathophysiology
➢ The pathologic process leading to OPLL begins with chondroblast- and fibroblast-like spindle cell proliferation, along with vascular infiltration leading to PLL degeneration and hypertrophy. Endochondral ossification follows, resulting in its replacement with mature lamellar bone
➢ Age, gender, and the number of levels affected by OPLL do not affect the prognosis
Clinical Presentation
➢ Changes in gait or balance, loss of fine motor control, and upper extremity weakness,numbness, or paresthesias are suggestive of myelopathy
➢Among patients in Japan with cervical spine disorders, the incidence has been estimated at 1.9% to 4.3% and, in other Asian countries, up to 3.0%
➢OPLL has been recognized as an etiology of myelopathy regardless of ethnicity, with an estimated incidence rate of 0.1% to 1.7% among North Americans and Europeans
➢ Genetics,local tissue characteristics, and associated medical comorbidities have all been implicated in this final common pathway
➢ Medical comorbidities are also associated with the development of OPLL
Pathoanatomy
➢ The PLL runs along the dorsal surface of the C1 anterior arch and cervical vertebral bodies and consists of longitudinal fibers confluent with the tectorial membrane cranially and ending at the sacrum caudally
➢In patients with myelopathy, 64% had deteriorated,
however, and 89% of patients with Nurick grade 3 or 4 myelopathy who refused surgery had progressed to a wheelchair- or bed-bound state