| Research purpose:Ossification of the Posterior Longitudinal Ligament of the Cervical Spine(C-OPLL)is a kind of pathological phenomenon characterized by the apperance of heterotopic ossification in posterior longitudinal ligament.Pathogensis of C-OPLL remains unclear at present.Heterotopic ossification in posterior longitudinal ligament usually leads to the injury of cervical spinal cord,causing a series of clinical symptoms,such as neck and shoulder pain,numbness of limbs,activities limitation and even dysfunction of balder and rectum.In recent years,along with the development of the imaging examination technology and the improvement of understanding of C-OPLL,diagnosis rate of C-OPLL is still increasing.The incidence of C-OPLL is gradually increasing and the patients tend to be younger.In the past,the diagnosis of C-OPLL relies on CT scanning of cervical spine,which ignoring other parameters on X-ray.X-ray of cervical spine is more continent,faster and cheaper than CT and MRI of cervical spine.Based on the cervical physiological curvature,the range of cervical spine motion on X-ray,this research focuses on the influenced factors of neurological function such as age,gender,time of onset,cervical spinal stenosis,canal occupying ratio of the cord of ossified mass and the change of signal intensity on T2-weighted images of MRI.Research Methods:1.The parameters of X-ray(lateral view and flexion and extension view)of outpatients and inpatients were measured and analyzed retrospectively in Changzheng Hospital affiliated to the Second Military Medical University from January,2014 to January,2017.That is,the curvature of the cervical spine,the range of motion,the most severe segments of the stenosis of the spinal stenosis rate,the control group selected C2-C7 segment Pavlov ratio of the minimum value of the cervical spine as a stenosis assessment of indicators.214 cases of patients with C-OPLL met the inclusion criteria,including 124 male and 90 female.The age ranged from 31 to 77 and the mean age was 56.21±10.44.Among these patients,175 cases had symptoms of spinal cord compression(113 male,62 female)and 39 cases had no symptoms of spinal cord compression(21 male,18 female).156 patients(78 male,78 female)from outpatient and health examination center were included into the control group.According to the age distribution,the patients were divided into three groups: A group(20 to 40),B group(41 to 60)and C group(61 to 80).2.C-OPLL was confirmed by CT images and they were all mixed type.93 cases of patients with mixed type of C-OPLL met the inclusion criteria,including 52 male and 41 female.The age ranged from 37 to 77 and the mean age was 57.73±9.89.The time of onset ranged from 13 to 145 months and the mean time was 50.72±25.92 months.JOA scores was used to evaluate the neurological function status.JOA scores ranged from 4 to 9 and the mean score was 6.17±1.12.The canal occupying ratio of the cord on CT ranged from 23.91% to 88.13% and the mean canal occupying ratio of the cord was 50.73±14.31%.The cervical spinal stenosis was confirmed in 47 patients(27 male,20 female).The change of signal intensity was confirmed by MRI T2-weighted images in 37 patients(22 male,15 female).Multiple linear regression was used to analyzed the influenced factors of neurological function such as age,gender,time of onset,cervical spinal stenosis,canal occupying ratio of the cord of ossified mass and the change of signal intensity on T2-weighted images of MRI.Research outcomes:1.The results of statisticalanalysisindicated that there was significant difference of cervical curvature among different age group and between C-OPLL group and control group.The range of motion of cervical spine decreased as the increase of age.The physiological curvature of the cervical spine increased with age,and the physiological curvature of the C-OPLL group was significantly lower than that of the control group.The range of motion decreased with age,and there was significant difference between sex group and C-OPLL group and control group(P <0.0001).2.The statistical analysis showed that the influence of age on the neurological function(JOA score)of mixed C-OPLL patients was statistically significant(P = 0.0019),the regression coefficient was-0.0424,and the 95% confidence interval was(-0.0688,-0.0161),The change of signal intensity was confirmed by MRI T2-weighted images showed that the influence on the neurological function(JOA score),and the regression coefficient was-0.8959.The difference was statistically significant(P <0.001),95% confidence interval(-1.3173,-0.4745),and there was no statistically significant difference between the other factors(P> 0.05).Conclusion:1.Cervical spine curvature and the range of motion with the growth of physiological changes,studies have shown that cervical spine and the range of motion differences in C-OPLL patients and C-OPLL patients between the age group has a certain statistical Significance,C-OPLL patients with physiological curvature and the range of motion decreased significantly,positive rate of cervical spinal stenosis in the age group compared with a partial statistical significance.The results of this study have a certain significance,the results for the clinical workers on the posterior longitudinal ligament ossification of cervical spine X-ray parameters related to changes in the understanding of indicators to provide some information,is conducive to attention to cervical X-ray findings,Longitudinal ligament ossification patients.2.Symptoms of neurological dysfunction in patients with mixed C-OPLL have a certain relationship with age.MRI-T2-like changes in spinal cord signaling have a greater impact on neurological function in patients with mixed C-OPLL,but the age,sex,Course of disease,cervical spinal stenosis,spinal canal dissection of ligamentous ectopic bone and T2-weighted MRI-like spinal cord signal changes in these factors can explain the mixed C-OPLL patients with neurological function of about 48.93% of the reasons for variation.In clinical work,attention to these factors,especially the MRI of the T2 cervical spinal cord signal changes in the assessment of C-OPLL patients with disease progression or prognosis has a certain significance. |
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