脊髄外科
Online ISSN : 1880-9359
Print ISSN : 0914-6024
ISSN-L : 0914-6024
症例報告
胸椎後縦靭帯骨化に黄色靭帯骨化を同レベルに伴った脊髄症状に対する外科治療―4例の報告と文献的考察―
佐々木 強山縣 徹高 沙野大西 洋平後藤 浩之神崎 智行生野 弘道西川 節
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ジャーナル フリー

2021 年 35 巻 3 号 p. 320-327

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  Myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) combined with ossification of the yellow ligament (OYL) at the same level is not rare, but surgical management of this lesion is controversial. We reported four cases and reviewed the literature on surgical therapy.

  Case 1 : A 42-year-old man developed severe transverse cord syndrome up to T3, with a Japanese Orthopaedic Association (JOA) score of 3. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated OPLL and OYL in the upper and middle thoracic spine. Laminectomy of T2, 3, and 4 were performed. Post-op 6 month JOA score recovery rate (RR) was 25.0%.

  Case 2 : A 48-year-old man developed severe transverse cord syndrome up to T5 with a JOA score of 6. CT and MRI demonstrated OPLL and OYL in the middle thoracic spine. Laminectomy of T4-5 was performed. Post-op 6 months RR was 44.4%.

  Case 3 : A 67-year-old woman developed severe transverse and Brown-Séquard type myelopathy up to T5, JOA score of 6. CT and MRI demonstrated OPLL and OYL in the middle thoracic spine. Laminectomy of T3-4 and laminoplasty for T5, 6, and 7 were performed. Post-op 6 months RR was 60.0%. Kyphosis deteriorated.

  Case 4 : A 45-year-old woman developed severe transverse and Brown-Séquard type myelopathy up to T3, JOA score of 5. CT and MRI demonstrated OPLL and OYL in the upper and middle thoracic spine, respectively. Laminoplasty for T3, 4, 5 and posterior lateral fixation (PLF) for T5/6/7 were performed. Post-op 6 months RR was 85.7%.

  The ossificaion-kyphosis angle was useful in deciding the operative indication. One-staged posterior decompression and fixation should be considered in patients with long lesions and kyphosis. Careful long-term follow-ups are necessary.

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© 2021 日本脊髄外科学会
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