With the extensive development of spinal surgery, cervical vertebral ligament ossification of cervical vertebrae, thoracic vertebrae and lumbar vertebrae is not uncommon in clinical observations, especially after the two advanced technologies of CT and MRI, the diagnosis rate and discovery The rate has increased significantly. There are many cases of compression or stimulation of the spinal cord, and severe cases require surgical resection.
(1) Causes of the disease
Most of the activity and weight of the spine can be related to tissue degeneration.
Whether the ossification of the ligamentum flavum and the calcification of the ligamentum flavum is the same disease, or two different diseases, the opinions are not uniform; especially for cases that occur in the cervical spine. The claim is that the two diseases believe that the former is more common in men, except for the spine, other parts of the body have no ossification, and easy to adhere to the dura mater and lamina; while the latter is more common in women, other parts of the body can be found calcification, And no adhesion to the dura mater and lamina, no continuity. It is argued that the two patients with the same disease believe that the basic pathological changes of the two are similar, and that calcification is very rare, so they should be regarded as different stages of development of the same lesion. From the point of view of clinical diagnosis and therapeutics, the two do not necessarily need to be distinguished. Especially in the current situation of self-discipline, the clinician should still be based on the principle that the patient can relieve the pain.
Magnetic resonance imaging (MRI) blood routine CT examination of spinal MRI examination of bone and joint soft tissue CT examination
1. Simple X-ray film and tomography: On the X-ray lateral slice of the cervical vertebra, there are abnormal shadows behind the vertebral body. The large ossified shadow of the white stick is a continuous ossification type, and the large ossification of the ossification is a mixed type, and the diagnosis is easy. However, small ossifications such as segmentation and localization may cause misdiagnosis by X-ray film diagnosis alone. Lateral tomography of the cervical spine is often required. On the tomogram, a white rod-like protrusion thicker than the vertebral body can be photographed and adhered to the back of the vertebral body.
2. CT examination: CT examination of the cervical cross-sectional state is extremely useful for the diagnosis of this disease. In general, when three layers of scanning images are taken within the scope of a vertebral body, the osteoporosis (OPLL) in the spinal canal is clearly displayed. The morphology of the bones varies from large to large and small and sharp. In addition, the degree of maturity of ossification can also be seen from the CT index, which is crucial for the choice of treatment methods, especially for surgical procedures.
3. MRI examination: In recent years, MRI examination has been widely used in the diagnosis of cervical and cervical spinal cord, especially for the diagnosis of disc disease and spinal cord lesions. However, for this disease, its specificity is not too high, because the ossified shadow appears as a low signal on the MRI image, it is difficult to distinguish it from the epidural tissue around it, the normal posterior longitudinal ligament, etc. The shape of the spinal cord that is thinned by the compression of the ossification site. In addition, MRI examination is also important for the differential diagnosis of cervical spondylotic myelopathy, cervical disc herniation, and spinal cord tumors.
(1) Myelography: It is often necessary to use myelography to determine the location of the operation. For the angiography, the cerebellar medullary side puncture method is used for the angiography, and the lumbar puncture method is used for the ascending stenosis. The surgical site can be determined from the stenosis and obstruction signs seen in the radiography. CT (CTM) examination can also be performed to understand the stenosis from the CT cross section of myelography.
(2) Intervertebral disc angiography: If the ossification of the posterior longitudinal ligament of the cervical spine is the main reason and can discriminate the disc disease, it is not necessary to do discography. However, when disc herniation may be the main cause of disease and lack of MRI technique, discography should be performed to understand the disc change and whether there is induced pain during observation.
(3) EMG examination: EMG examination also has significance for the diagnosis of the level and extent of neurological symptoms, and may be used as appropriate.
The diagnosis should be differentiated from the following symptoms:
1. Yellow ligament ligament hypertrophy
The ligamentum flavum is not continuous, and the ligamentum flavum on both sides has a fissure on the midline. It starts from the anterior and posterior aspect of the superior lamina and ends on the posterior top of the lower lamina. Hypertrophy of the ligamentum flavum may be related to factors such as chronic degeneration, trauma, inflammation, and metabolic disorders. It can occur at any age and progresses rapidly and to a greater extent.
2. Triangle ligament injury
A tibiofibular fracture located at the level of the lower tibiofibular ligament may be associated with an avulsion fracture or a triangular ligament injury; the posterior margin of the humerus may be intact or show a triangular bone avulsed by the posterior tibiofibular ligament.
3. Formation of hematoma in the broad ligament
Obstetric ligament hematoma is one of the serious complications of obstetrics, which can occur at the time of delivery or postpartum.
In the early stage, the sagittal diameter of the spinal canal can be free of any symptoms; however, the development of the sagittal diameter of the spinal canal is prone to spinal cord compression, which is as follows:
It first appeared, mainly because the pressure was from the back of the spinal canal. The severity and extent of the lesion are directly proportional to the extent of the lesion and the course of the disease, and inversely proportional to the size of the sagittal diameter of the spinal canal.
2. Movement disorders
More often in the second 2 to 3 months after the former, the lower extremity muscle tension increased, easy to fall, weakness and easy to fall, etc. for early onset, severe cases occur paralysis.
3. Local symptoms of the vertebral section
Often not obvious, a small number of cases may have neck pain or chest and lumbar pain, and may be associated with symptoms of dysfunction such as restricted or increased numbness when the activity is limited.