Morphometric Study of the Lumbar Posterior Longitudinal Ligament

OBJECTIVE: Morphometric data for the lumbar posterior longitudinal ligament (PLL) was investigated to identify whether there is a difference in the morphometry of the PLL of the lumbar spine at each level with respect to the pattern of intervertebral disc displacement. METHODS: In 14 formalin-fixed adult cadavers (12 males and 2 females), from L1 to L5, the authors measured the width and height of the PLL and compared them with other landmarks such as the disc and the pedicle. RESULTS: Horizontally, at the upper margin of the disc, the central portion of the superficial PLL covered 17.8–36.9% of the disc width and the fan-like portion of the PLL covered 63.9–76.7% of the disc width. At the level of the median portion of the disc, the PLL covered 69.1–74.5% of the disc width. Vertically, at the level of the medial margin of the pedicle, the fan-like portion of the PLL covered 23.5–29.9% of the disc height. In general, a significant difference in length was not found in the right-left and male-female comparisons. CONCLUSION: This study presents the morphometric data on the pattern of intervertebral disc displacement and helps to improve the knowledge of the surgical anatomy of the lumbar PLL.

Morphometric Study of the Lumbar Posterior Longitudinal Ligament

OBJECTIVE: Morphometric data for the lumbar posterior longitudinal ligament (PLL) was investigated to identify whether there is a difference in the morphometry of the PLL of the lumbar spine at each level with respect to the pattern of intervertebral disc displacement.METHODS: In 14 formalin-fixed adult cadavers (12 males and 2 females), from L1 to L5, the authors measured the width and height of the PLL and compared them with other landmarks such as the disc and the pedicle.RESULTS: Horizontally, at the upper margin of the disc, the central portion of the superficial PLL covered 17.8–36.9% of the disc width and the fan-like portion of the PLL covered 63.9–76.7% of the disc width. At the level of the median portion of the disc, the PLL covered 69.1–74.5% of the disc width. Vertically, at the level of the medial margin of the pedicle, the fan-like portion of the PLL covered 23.5–29.9% of the disc height. In general, a significant difference in length was not found in the right-left and male-female comparisons.CONCLUSION: This study presents the morphometric data on the pattern of intervertebral disc displacement and helps to improve the knowledge of the surgical anatomy of the lumbar PLL.

MRI in diagnosis of cervical posterior longitudinal ligament rupture / 中华全科医师杂志

Magnetic resonance imaging (MRI) data of 87 patients with suspected cervical posterior longitudinal ligament (PLL) rupture,who underwent cervical spine surgery in Luoyang Orthopedic Hospital from January 2015 to September 2017,were analyzed retrospectively.The criteria of MRI diagnosis for PLL rupture were the low signal image of the PLL on the posterior margin of the vertebral body,the discontinuity or continuous interruption,or the local highlighting signal on the T2 weighted image.According to intraoperative findings,the diagnostic accuracy of MRI for PLL rupture was examined.Among 87 patients,31 cases were diganosed as PLL rupture by preoperative MRI;and 38 cases were confirmed by intraoperative exploration,of whom 30 were diagnosed with MRI,and 8 were missed by MRI.The accuracy,sensitivity and specificity of MRI in the diagnosis of ruptured PLL were 0.90,0.79 and 0.98 respectively.MRI has a good diagnostic efficiency in PLL rupture,which can be used for preoperative investigation.

Anterior Longitudinal Ligament Reconstruction to Reduce Hypermobility of Cervical and Lumbar Disc Arthroplasty

STUDY DESIGN: Retrospective case series PURPOSE: This study aims to present the early clinical and radiological outcomes of anterior longitudinal ligament (ALL) reconstruction following disc arthroplasty. OVERVIEW OF LITERATURE: Although cervical and lumbar disc arthroplasty have entered the clinical setting, there are still concerns regarding the short and long term complications arising from hypermobility of current prosthesis designs. Reconstruction of the ALL is a potential solution to disc arthroplasty hypermobility. METHODS: ALL reconstruction following disc arthroplasty have been performed by the senior author over a 24 month period. Ligament replacements used include allograft and synthetic, ligament advanced reinforcement system (LARS) ligaments. Methods of fixation used include titanium staples, bone anchors and suture fixation. Radiological follow-up pre- and postoperative Oswestry disability index, Neck Disability Index, Patient Satisfaction index scores were recorded on all patients. RESULTS: A total of 18 ALL reconstructions were performed. There have been no cases of early complications, revision surgery for recurrent symptoms or implant failure. Of the 6 patients receiving a minimum of 15 months follow-up, 4 patients received an allograft, 2 patients received the LARS ligament. Favourable, postoperative clinical and radiographic outcomes have been demonstrated. CONCLUSIONS: ALL reconstruction following cervical and lumbar disc arthroplasty is a promising solution to addressing non-physiological kinematics of current disc arthroplasty devices. Randomized, controlled studies with larger study samples and long-term follow-up are required to establish these conclusions.

Reoperation for cervical myelopathy duo to progressing ossification of the posterior longitudinal ligaments in patients with expansive laminoplasty / 北京大学学报(医学版)

Objective:To retrospectively analyze the clinical data of the patients with reoperation for cervical myelopathy due to progressing ossification of the posterior longitudinal ligaments,with previous open-door expansive laminoplasty,and to evaluate the outcomes.Methods:From May 2006 to July 2012,a retrospective study was performed on a consecutive series of 17 patients with previous open-door expansive laminoplasty,who had received the reoperation for cervical myelopathy due to progressing ossi-fication of the posterior longitudinal ligaments.The reoperation was performed based on the clinical mani-festations and segments of responsibility.The anterior approaches were performed in 12 cases,and the posterior approaches in 5 cases.The correlation between the clinical factors and Japanese Orthopedic As-sociation (JOA)scores or the JOA recovery rate was evaluated by Pearson or Spearman correlation test. The pre-and post-operative JOA scores were analyzed by repeated measures ANOVA and the JOA recovery rates were compared with paired t test.Results:The mean follow-up was 137.5 months (range 60-348 months).There were no serious complications after surgical procedures.There was one case that had C5 palsy in the first operation and had recovery after one week.Another case had C5 palsy in the reoperation with posterior approach,which had recovery at the end of 6 months post-operation.Three cases had the cerebrospinal fluid leakage of the reoperation,with two cases in the anterior approaches and one case in the posterior approach.There was no significant correlation between the clinical variables and JOA scores or JOA recovery rates.The JOA scores of the patients in the first operation were improved from 9.4 ±4.1 to 12.8 ±2.8 (P<0.01),and the JOA recovery rate was 45.6%.The JOA scores of the reoperation were improved from 10.2 ±2.8 to 12.7 ±2.4 (P<0.05)at the end of 6 months and 14.3 ±1.9 (P<0.01)by the last follow-up.There were significant differences between the JOA recovery rates by the last follow-up (63 .2%)and at the end of 6 months (39 .3%)of the reoperation or 45 .6%of the first opera-tion (P<0.01).Conclusion:The reoperation for cervical myelopathy duo to progressing ossification of the posterior longitudinal ligaments can significantly promote the recovery of the spinal cord,based on the clinical manifestations combined with segments of responsibility of the imaging.

Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review

Only a few cases of anterior longitudinal ligament (ALL) injury related with retropharyngeal hematoma without fracture have previously been reported. The treatment of choice for retropharyngeal hematoma is generally considered to be conservative care, but we believe that early surgery of this pathology would be better in certain situations. Here, we describe two cases with life-threatening large retropharyngeal hematomas related with ALL injuries and operated on at an early stage. Two previously healthy patients visited the emergency room with neck pain and dyspnea after falling. Serious neck swelling was observed and lateral neck X-ray showed severe widening of the prevertebral space. Due to dyspnea progression, emergency endotracheal intubation was performed. Although there was no primary cause of the retropharyngeal hematoma on preoperative examination, ALL tearing was intraoperatively confirmed during early surgery. The in-hospital evolutions of the patients were favorable after surgery. We should bear in mind the possibility of ALL injury and perform early surgery where possible given the earlier convalescence and good prognosis.

Avaliação da redução por ligamentotaxia nas fraturas toracolombares tipo explosão / Evaluation of the reduction by ligamentotaxis in thoracolumbar burst fractures / Evaluación de la reducción por ligamentotaxia en las fracturas toracolumbares tipo explosión

Avaliar a correção da cifose, da altura do corpo vertebral e da redução dos fragmentos retropulsados nas fraturas toracolombares tipo explosão por ligamentotaxia. MÉTODOS: estudo retrospectivo avaliando um total de 238 pacientes com fraturas toracolombares tipo explosão do grupo A3 pela classificação de Magerl et al., dos quais 63 deles elegíveis para a pesquisa. Todos foram tratados com fixador interno pedicular e tinham imagens radiográficas e tomográficas pré e pós-operatórias. RESULTADOS: No estudo, foi constatada, no pós-operatório imediato, uma correção da cifose vertebral no local da fratura de 87 por cento, com correção de 51 por cento na altura do corpo vertebral e redução de 40 por cento dos fragmentos retropulsados intracanal. CONCLUSÕES: o uso de fixador interno por via posterior permite, ao realizar ligamentotaxia, a restauração da altura do corpo vertebral fraturado, do alinhamento sagital da coluna e descompressão do canal espinhal, minimizando as comorbidades em relação à cirurgia pela via anterior e à laminectomia para descompressão do canal.

To evaluate the correction of kyphosis, of the vertebral body height and the reduction of the retropulsed fragments in the thoracolumbar burst fractures by means of ligamentotaxis. METHODS: retrospective study evaluating a total of 238 patients with thoracolumbar A3 burst fractures based on the classification by Magerl et al., of which 63 were eligible to the research. All patients had been treated with pedicular internal fixation and had previous and postoperative radiographs and computed tomographic images. RESULTS: the study evidenced an immediate postoperative correction of vertebral kyphosis in the fracture site in 87 percent of the cases, with correction of 51 percent in the vertebral body height and reduction of 40 percent the intra-canal retropulsed fragments. CONCLUSIONS: the use of internal fixation by anterior approach allows, through ligamentotaxis, the restoration of the height of the vertebral body fracture, of the sagittal alignment of the column and spinal canal decompression, thus minimizing the comorbidities in relation to the surgery by anterior approach and laminectomy to canal decompression.

Evaluar la corrección de la cifosis, de la altura del cuerpo vertebral y de la reducción de los fragmentos retro pulsados en las fracturas toracolumbares tipo explosión por ligamentotaxia. MÉTODOS: estudio retrospectivo evaluando un total de 238 pacientes con fracturas toracolumbares tipo explosión del Grupo A3 por la clasificación de Magerl et al., de los cuales 63 de ellos fueron elegidos para la investigación. Todos fueron tratados con fijador interno pedicular y tenían imágenes radiográficas y de tomografías pre y postoperatorias. RESULTADOS: en el estudio, se constató en el postoperatorio inmediato una corrección de la cifosis vertebral en el local de la fractura de 87 por ciento con corrección de 51 por ciento en la altura del cuerpo vertebral, y una reducción de 40 por ciento de los fragmentos retro pulsados intracanal. CONCLUSIONES: el uso del fijador interno por vía posterior permite, al realizar ligamentotaxia, la restauración de la altura del cuerpo vertebral fracturado, del alineamiento sagital de la columna y descompresión del canal espinal minimizando la comorbidad en relación a la cirugía por vía anterior y la laminectomía para descompresión del canal.

How to determine whether adhesion between posterior longitudinal ligament and spinal dura mater exists or not / 中华骨科杂志

Objective To evaluate retrospectively whether posterior longitudinal ligament(PLL)adhere to dura mater in the patients with cervical spondylotie myelopathy(CSM)or not before the anterior cervical operation.Methods From December 2005 to January 2007,of 18 patients with CSM the adhesion between PLL and dura mater was found in the anterior cervical operation.The patients included of 11 males and 7 females,with mean age of 65.4 years (range 55-72 years).All the patients were measured by CT and MRI before operation.There were 12 cases of dual-segmental cervical intervertebral disc herniation,6 of tri-segmental disc herniation.The former cases were treated with one level corpectomy and titanium mesh or iliac grafting and cervical anterior plate,and the latter with an additional cervical cage in the intervertebralspace.The floatation method was used to deal with the adhesion.The fitness between the two radiological methods was analyzed by matched-pairs Kappa eoemcient test.Results The nerve functions of all the patients were improved after anterior cervieal decompression.The mean score of JOA was increased from 9.6 of pre-operation to 12.1 of post-operation.There were 4 cases with injury in dura mater,which healed after appropriate dealing with the leakage of cerebrospinal fluid.None of lacerated dura was directly repaired during the operation.The condition of the coarse touch and bur between intervertebral disc and dura mater were found in CT transverse scanning.The thickening of the PLL and the unsymmetrical space between inferior and superior subdural cavity was found in MRI.The coefficient test proved that the difference of the CT and MRI was significant in finding the adhesion.Conclusion MRI iS better than CT in finding the adhesion between the PLL and dura mater in CSM before operation,besides the floatation method should be good to deal with the adhesion.

Improved Z-open door expensive laminoplasty for cervical ossification of the posterior longitudinal ligament / 中国矫形外科杂志

[Objective]To investigate the effects of the expansive Z-open-door laminoplasty for the ossification of posterior longitudinal ligaments(OPLL).[Methods]Thirty-six cases of OPLL were operated by the expansive Z-open-door laminoplasty.According to JOA score(17 Points) the proximate effects of all patients were analyzed.[Results]All cases were followed-up for average 18.6 months.JOA improved from 8.3 preoperatively to 13.8 postoperatively.Improved rate averaged 58.6%.Image show:3 of 31cases of anterior protruding type were changed to straight type,5 cases of straight type still kept initial type.None of all cases changed into posterior protruding type after operation.The flexion and extention range of the neck were less 1/3 and the axis-ward pain happened commonly.[Conclusion]Improved expensive Z-open door laminoplasty for DPLL can decompression clearly.It has advantages of adeguate canal expansion,preventing re-dosing the door,and being safe and reliable.

Study on diversification of quantity of collagen and proteoglycan and calcium in the posterior longitudinal ligament of the human cervical spine / 中国矫形外科杂志

[Objective]To study the mechanism of posterior longitudinal ligament in cervical spine through measuring the collagen and Proteoglycan and Calcium changes.[Method]Fifteen specimens of cervical longitudinal ligament from cervical spondylotic myelopathy(CSM)and ten control specimens from corpses without cervical spondylosis were obtained.The content of the collagen was measured by Weossner method.Collagen type Ⅰ and Ⅱ were measured by Enzyme-Linked Immunosorbentassay(ELISA)method.Phloroglucinol spectrophotometer to determine the change of amount of Proteoglycan.The Calcium by Methyl-Thymes-Blue(MTB)Colorimetric Method.The specimens were treated hy Hematoxylin and Eosin(HE)stain method and by Masson stain method,the pathological changes of two groups were observed through microscopy.[Result]In CSM,as compared to the control groups,there showed a decrease in the contents of the total Collagen,Collagen type Ⅰ and Proteoglycan,and increase in the content of collagen type Ⅱ.The rate of type Ⅰ/Ⅱ in CSM was lower than that in control groups.An increase in the content of the Calcium.All of which have statistic significance(P

One stage anteroposterior decompression and internal fixation for ossification of posterior longitudinal ligament / 中华创伤杂志

Objective To evaluate and analyze the results of one stage anteroposterior decompression and internal fixation for ossification of posterior longitudinal ligaments (OPLL). Methods One stage anteroposterior decompression and fixation was carried out from October 2001 to March 2004 in eight cases of OPLL including seven males and one female with age of 32-55 years (average 48.2 years). Results All cases were followed up for 6-30 months. According to criteria of Japan Orthopedic Association (JOA), the postoperative JOA score increased for 1-8 scores (mean 4.5 scores). The postoperative improvement rate of symptom was 50%. Conclusion One stage anteroposterior decompression and internal fixation is a good alternative method for treatment of OPLL, for it has advantages of complete decompression, reliable therapeutic effect and sound recovery.

Posterior operation for thoracolumbar spinal fracture and dislocation complicated with longitudinal ligaments and intervertebral disc rupture / 中华骨科杂志

Objective To explore surgical treatment through posterior approach to reduce the fracture and dislocation complicated with longitudinal ligaments and intervertebral disc rupture in the thoracic or lumbar spine. Methods Eighteen cases suffered from the fracture and dislocation complicated with longitudinal ligaments and intervertebral disc rupture in the thoracic or lumbar spine between January 2001 and May 2004, retrospectively were reviewed all the patients are male, aged from 19 to 58 years old (average 38 years). All the patients are paraplegia. The involved vertebrae are T11 to L 3. All the lateral X-ray films showed the fractured vertebra taking on wedged shape. The posterior vertebral body-height was decreased in six patients. The fractured vertebra lost its height by 1/4 to 3/4 of normal height. The upper vertebral dislocation extent was from 25% to 100%. Two cases complicated with lateral displacement. All the patients were operated on within posttraumatic 10 days. One of the two posterior surgical techniques was used for a given patient: 1) One technique is implantation of pedicle-screws in upper and lower vertebrae just adjacent to fractured vertebra. 2) Another technique is implantation of pedicle-screws both in fractured vertebra and its adjacent upper and lower vertebrae. Results All the patients were followed up 3 months to 3 years (average 18 months). 8 cases were treated with two-vertebrae 4 pedicle-screws implantation technique, the height of fractured vertebral body was not improved in 5 cases, partially improved in 3 cases. The dislocation of the upper vertebra adjacent to fractured vertebra was partially improved in 6 case, not changed in 1 case, got worse in 1 case. 10 cases were treated with three-vertebrae 6 pedicle-screws implantation technique, the height of fractured vertebral body was all improved by 80% to 100%. The dislocation of the upper vertebra was corrected completely in all the ten cases. Conclusion The procedure of three-vertebrae 6 pedicle-screws implantation is practical, effective and useful for treatment of the fracture and dislocation comlicated with longitudinal ligaments and intervertebral disc rupture in the thoracic or lumbar spine.