Imaging analysis of ossification of the nuchal ligament with cervical curvature and segmental stability / 中国组织工程研究

BACKGROUND: In degenerative cervical spondylosis associated with cervical curvature straightening or segmental instability, ossification of the nuchal ligament caused by chronic injury of the nuchal ligament is very common. OBJECTIVE: To investigate the correlation between ossification of the nuchal ligament and cervical curvature and segmental stability of the cervical spine. METHODS: Data of 109 patients with degenerative cervical spondylosis, who were treated in Department of Spinal Surgery of Affiliated Hospital of Xuzhou Medical University from October 1, 2017 to October 31, 2018, were retrospectively analyzed. There were 61 male patients and 48 female patients, who aged 30 to 81 years old at a mean age of (55. 8±11. 1) years. All patients signed the informed consent. This study was approved by the Ethics Committee of Affiliated Hospital of Xuzhou Medical University. The patients underwent the X-ray examinations of cervical spine. The imaging observation included the distribution and degree of ossification of the nuchal ligament and the change of cervical physiological curvature and segment stability. The patients were divided into ossification group and non-ossification group according to whether or not the patients had ossification of the nuchal ligament. Gender, age, cervical curvature and lower cervical stability were compared between the two groups. Pearson correlation analysis was used to compare the relationship between the degree of ossification of the nuchal ligament and cervical curvature and cervical stability. Binary Logistic regression analysis was applied to evaluate the significant risk factors for the development of ossification of the nuchal ligament. RESULTS AND CONCLUSION: (1) Of 109 patients with degenerative cervical spondylosis, 56 patients with ossification of the nuchal ligament and ossification involved 83 cervical segments in ossification of the nuchal ligament patients, most of which were C4-5 (39. 8%) and Cm (42. 2%). (2) There was significant difference in age, C2-C7 Cobb angle, Jackson physiological stress curve, parameter angular displacement and horizontal displacement between the ossification group and non-ossification group (P < 0. 05). The degree of ossification of the nuchal ligament was positively correlated with angular displacement (f=0. 486, P < 0. 05). (3) The incidence of ossification of the nuchal ligament was significantly higher in patients with lower cervical instability (P < 0. 05). Age and lower cervical instability parameter angular displacement were significant risk factors for the development of ossification of the nuchal ligament. (4) Patients with ossification of the nuchal ligament are more likely to have cervical curvature straightening and lower cervical instability, especially in the segment instability. In the diagnosis and treatment of degenerative cervical spondylosis, the existence of ossification of the nuchal ligament causes corresponding attention.

B-mode ultrasonography and gray scale histogram for evaluation of the nuchal ligament in Quarter horse / Ultrassonografia modo-B e histograma em escala de cinza para avaliação do ligamento nucal em equinos da raça Quarto de Milha

The gray scale histogram (GSH) makes it possible to measure the amount and distribution of gray shade frequencies, providing quantitative information on both echogenicity and echotexture of tissues. There is a need to diminish the subjectivity of the ultrasound images of the nuchal ligament (NL). This work proposes to evaluate the NL by ultrasound B-mode GSH images in different ages of Quarter horses. It used 15 healthy Quarter horses, which were classified by age into three different groups: "baby" (1), "sobreano" (2) and "adult" (3). The animals were submitted to chemical restraint for the ultrasound examination. Subsequently, the GSH tool was used in each image for statistical analysis. There was a significant difference between Mean and Mode between groups. Group 1 differed significantly when compared to Group 2 and 3. Group 2 presented superior echogenicity to Group 1 and 3. The height of the NL did not vary considerably between groups. GSH indicated that the echogenicity of NL in Quarter horses varies with age.(AU)

O histograma em escala de cinza (HEC) possibilita a mensuração da quantidade e distribuição da frequência de tonalidades de cinza, fornecendo informações quantitativas, tanto sobre a ecogenicidade quanto a ecotextura dos tecidos. Havendo a necessidade de diminuir a subjetividade das imagens ultrassonográficas do ligamento nucal (LN), esse trabalho propôs avaliar o LN por imagens ultrassonográficas modo-B pelo HEC em diferentes idades de cavalos da raça Quarto de Milha. Utilizou 15 cavalos da raça Quarto de Milha saudáveis os quais foram classificados por idade em três grupos diferentes: "baby" (1), "sobreano" (2) e "adulto" (3). Os animais foram submetidos a contenção química para a realização do exame ultrassonográfico. Posteriormente, a ferramenta HEC foi empregada em cada imagem para análise estatística. Houve diferença significativa entre as variáveis "Mean" e "Mode" entre os grupos. O Grupo 1 diferenciou significativamente quando comparado ao Grupo 2 e 3. O Grupo 2 apresentou ecogenicidade superior ao Grupo 1 e 3. Quanto à altura do LN não teve variação considerável entre os grupos. O HEC indicou que a ecogenicidade do LN em cavalos Quarto de Milha varia conforme a idade.(AU)

Increased Prevalence of Ossification of Posterior Longitudinal Ligament and Increased Bone Mineral Density in Patients with Ossification of Nuchal Ligament

OBJECTIVE: There are also few studies demonstrating the relationship between ossification of nuchal ligament (ONL) and ossification of posterior longitudinal ligament (OPLL). We compared the prevalence, location, and type of OPLL between patients with ONL and matched patients without ONL.We also compared the bone mineral densities (BMDs) between the 2 groups. METHODS: total of 124 cervical ONL patients were enrolled in this study. The control group of 124 patients was matched with 124 patients with ONL by age and sex on a 1:1 basis to minimize confounding factors. We reviewed the prevalence, location, and type of OPLL in both groups. RESULTS: The prevalence of OPLL was almost 2.5 times greater in patients with ONL than those without ONL. The mean value of BMD in patients with ONL was greater at the lumbar spine (L1-L4) than in patients without ONL. The mean T score of the lumbar spine was 0.25±1.68 in the patients with ONL and -0.73±1.64 in the patients without ONL. CONCLUSION: The prevalence of OPLL in patients with ONL was significantly higher than in patients without ONL. Because ONL is innocuous and may be seen more readily than OPLL on simple cervical radiographs, clinicians should consider the possibility of coexisting OPLL when ONL, especially extensive ONL, is detected in patients with neck pain, radiculopathy, or myelopathy, to facilitate proper treatment.

Study on the nuchal ligament ossification on lateral cephalometric radiograph / 대한구강악안면방사선학회지

PURPOSE: The purpose of this study was to assess the prevalence and radiographic characteristics of the nuchal ligament ossification on lateral cephalometric radiographs in Koreans. SUBJECTS AND METHOD: I review and interpreted the lateral cephalometric radiographs from 4,558 patients (1,857 males and 2,701 females, age range from 2 to 79 years) who visited the Kyungpook National University Dental Hospital from January 1, 2008 to February 3, 2009. I grouped the shapes of nuchal ligament ossification as round, rod-like, and segmented shape. And localized the ossification as the involvement of anterior cervical vertebral body. The data were analyzed by using chi-squared test with two-tailed and at a 5% significance level. RESULTS: Among those who showed the nuchal ligament ossification, the mean age of the 143 males was 51.1 and that of the 97 females was 48.0 years. It was not observed completely below teens, and was observed 1% in twenties, 6.1% in thirties, 18.6% in forties, and 26.3% over fifties. It was significantly prevalent in older age group (P<0.01) and in males than females among the same age group (P<0.05). The shapes of nuchal ligament ossification were as follows in order of frequency : rod-like (49.2%), round (30.4%), and segmented (20.4%). The highest involvement of ossification was found at the level of C5 (67.9%), C4 (29.2%), C6 (22.9%), C3 (3.3%), C7 (2.9%), C2 (0.8%), and C1 (0.4%). CONCLUSION: The nuchal ligament ossifications on lateral cephalometric radiographs were showed as round, rodlike, or segmented shape. The nuchal ligament ossification is often observed after the age of 40 and is observed more frequently in males than females. The highest shape of nuchal ligament ossification was rod-like shape and the highest involvement of cervical spine was C5.