Appendix: Diagnostic Criteria for OPLL and Diagnosis and Treatment Algorithm

Transcription

1 Appendix: Diagstic Criteria for OPLL and Diagsis and Treatment Algorithm Diagstic Criteria for Ossification of the Posterior Longitudinal Ligament of the Cervical Spine (Proposed by the Committee for Development of Clinical Practice Guidelines for OPLL) The definition of OPLL proposed by the Committee is ossification of the posterior longitudinal ligament of the cervical spine that causes clinical signs and symptoms. Thus, OPLL fulfills the following conditions: (1) OPLL is recognizable on a plain lateral radiograph. When the lower cervical spine is t well delineated in a plain lateral radiograph, tomograms or computed tomography (CT) scans can be obtained. However, a small, ossified lesion that can be recognized only with CT is t considered OPLL. (2) There must be an association of one or more of these clinical syndromes: compression myelopathy, radiculopathy, decreased neck motion secondary to OPLL with or without pain. Diagsis and Treatment Algorithm for Ossification of the Posterior Longitudinal Ligament (Proposed by the Committee for Development of Clinical Practice Guidelines for OPLL) A. When a patient complains of numbness in the peripheral parts of the extremities, clumsiness of the hands, or gait dysfunction 1. Does the patient have spastic paresis? Neurological examinations address the correct diagsis. Signs of myelopathy and radiculopathy should be carefully observed. Tendon reflexes of the upper extremities may be decreased or diminished owing to impaired secondary motor neurons. 2. Is OPLL revealed on the plain lateral radiograph? Two-view anteroposterior and lateral radiographs are mandatory (Fig. 1). If the X-ray projection is t correct, the posterior margin of the vertebral body delineates a dual shadow that mimics the segmental type of OPLL. 3. Does OPLL narrow the spinal canal? Measure the space available for the cord and calculate the occupancy rate (Fig. 2). 4. What is the severity of the myelopathy? Assess the severity of the myelopathy using the evaluation criteria for cervical myelopathy proposed by the Japanese Orthopaedic Association (JOA score). Check for other possible causes of cervical myelopathy such as cervical spondylotic myelopathy, spinal cord tumor, spinal bone tumor, and cervical spinal involvement of rheumatoid arthritis and then proceed to the treatment algorithm (Fig. 3). B. When a patient has axial symptoms 1. Does the patient have neurological signs? Follow the same diagstic process as in A and then proceed to the treatment algorithm (Fig. 4). 299

2 300 Committee for Development of Clinical Practice Guidelines for OPLL Fig. 1. Classification of ossification of the posterior longitudinal ligament (OPLL) by the Investigation Committee on the Ossification of Spinal Ligaments, Japanese Ministry of Health and Welfare B A Fig. 2. Space available for the spinal cord (SAC). A space of 6 mm is considered critical for myelopathy. Film-tube distance is 150 cm. Occupancy rate = (thickness of the ossified lesion/developmental anteroposterior diameter of the spinal canal) 100. Values 40 indicate a high likelihood of myelopathy

3 Appendix 301 Spastic paraplegia Plain X-ray Peripheral neuropathy Motor neuron disease etc. OPLL*2 Unclear diagsis neurologist Differential diagsis Image measurement Spinal canal stesis Orthopedic surgeon Disease severity mild severe Certified spine surgeon Fig. 3.

4 302 Committee for Development of Clinical Practice Guidelines for OPLL Neurological symptoms Plain X-ray Go to Fig. 3 OPLL*2 Differential digsis*6 Image measurement*3 Spinal canal stesis*4 mild severe Orthopedic surgeon Fig. 4.

5 Subject Index aberrant peripheral nerve bundles (APNB) 68 acromegaly 30, 34, 39, 116 adipocyte 82, 90 alkaline phosphatase (ALPase) 61, 95 anatomical structure of the posterior longitudinal ligament 41 androgen 39 animal model 71, 77 anterior decompression 193, 205, 237 anterior decompression procedures, thoracic OPLL 225, 227, 250 anterior floating method 166, 182, 209, 210 anterior horn neurons 102, 106 anterior procedure 181 anteroposterior (AP) diameter 34, 129 association study with candidate genes 19 astrocytosis 105 axial pain 197, 205 axial pain, lamiplasty 190 bone mineral density 14 bone morphogenetic protein (BMP)-2 61, 93, 95, 99 bone morphogenetic protein receptor (BMPR) 61 bone morphogenetic proteins 55, 59 boomerang shape of the spinal cord 67 brain stimulation 157 C5 nerve root palsy 211, 212 calcification 98 calcification of the ligamentum flavum 139 calciotropic hormones 37 calcium metabolic abrmality 29, 33 calciuric response 39 canal narrowing ratio 94 candidate genes 21 cartilage-derived morphogenetic protein 55 cartilagius cells 52 cerebrospinal fluid, leakage 222, 226, 237, 256 cervical myelopathy 30, 115 cervical orthosis 165 cervical traction 179 choice, surgical procedure 181, 222, 225, 266 chondrocyte-like cell 78, 79, 86 chromosome 21, 23 circumscribed-type, cervical OPLL 127, 135 circumspinal decompression 235, 240 classification of OPLL based on CT findings 133 classification of ossification of the posterior longitudinal ligament (OPLL) 127, 128 classification of thoracic ossification of the posterior longitudinal ligament (OPLL) 122 classification, OLF 265 clinical features 116 clinical manifestation of cervical OPLL 115 clinical manifestations of thoracic OPLL and OLF 121, 122 collagen 8, 21, 50, 61, 95 complication, lamiplasty 190 complications 237, 245, 256 complications, anterior floating method 211 compound muscle action potentials (CMAP) computed tomography 132 computed tomography, thoracic spine 145 computer-assisted imaging guidance system 278 connective tissue growth factor (CTGF) 78, 79 conservative treatment 165, 179 continuous-type, cervical OPLL 117, 127, 197 corticosteroids 165 cross-sectional shape of the spinal cord 67, 178 CT-myelography 135 CT-myelography, thoracic spine 146 definition of OPLL 299 dekyphosis stabilization 239 deterioration, cervical myelopathy 196 development of myelopathy 117 development of OLF 49 development of OPLL 29 development of the incipient small OPLLs 42 diabetes mellitus 13, 30, 34, 112, 220 diffuse idiopathic spinal hyperostosis 7, 11, 19, 24, 37 disc degeneration 43 dural membrane 42 dural ossification (DO) 42, 46 dynamic factors, myelopathy 14, 129, 165, 178 ectopic ossification 71, 73, 89 en bloc laminectomy 187, 266, 268 en bloc lamiplasty 219 endochondral ossification 52, 60 enthesis 52, 55, 99 epidemiological studies 7 estrogen 39 estrogen receptors 175 etidronate disodium 169 evaluation, spinal decompression 294 evoked spinal cord potentials (ESCPs) 112 evolution, lamiplasty 187 expansive lamiplasty

6 304 Subject Index expansive lamiplasty, thoracic spinal lesions 261 expansive open-door lamiplasty 193 expansive Z-plasty 187 extensive laminectomy 251 extent of progression 173 extirpation, ossified ligament 252 extracellular matrix genes 25 fenestration (lamitomy) 266 frameless stereotactic procedure 271 French-door laminectomy 266 gene encoding nucleotide pyrophosphatase 71 genetic analyses 8 genetic background 29 genetic factors 19 genetic linkage study 20 genetic survey 13 geme wide linkage study 23 glial cells 65 glucose intolerance 37, 77, 89 gray matter 65 growth hormone 39 halter traction 165 head compression test 165 hemilaminectomy 266, 268 high-signal intensity area, MRI 112, 205 hill-shaped OPLL 132 histopathology of the ligamentum flavum 50 history of OLF 49 HLA association 20, 21 HLA haplotype 8 human leukocyte antigen (HLA) 13 hyperinsulinemic 86 hyperleptinemia 80 hypertrophy of the posterior longitudinal ligament (PLL) 42, 68 hypoparathyroidism 29, 33, 116 Insulin-like growth factor (IGF) 79 Insulin-like growth factor (IGF)-1 85, 88, 89 Insulin-like growth factor (IGF)-I receptor β 83 image-guided surgery 271 immuhistochemical study of the spinal ligaments 61, 83 85, 102 incidence of OPLL 7, 29, 115 indications, anterior decompression through posterior approach 249 indications, anterior floating method 209 indications, cervicothoracic lamiplasty 241 indications, lamiplasty 190, 193, 201, 220 indications, surgical treatment 181 insulin 37, 79 insulin receptor β 83, 85 insulin receptor substrates (IRS) 37, 78, 83, internal rigid fixation 182 intramedullary hyperintensity, MRI 166 intramembraus ossification 43, 54 intraoperative spinal cord monitoring 157, 279 intraoperative ultrasography (IOUS) 264, 279, 287 The Investigation Committee on Ossification of the Posterior Longitudinal Ligament 3 irreversible pathological changes 67 Japanese disease 29 Japanese Orthopaedic Association (JOA) score 299 kyphosis 189, 194, 197, 201, 261, 294 kyphotic deformity 198, 219, 278 laminectomy 187 laminectomy membrane 219 lamiplasty 166, 187 late neurological deterioration 222 lateral column 66 lateral rachotomy 166 leptin 82, 88 leptin receptors 82 level diagsis 153 ligamentous hypertrophy 44 long-term (>10 years) results 182, 204, 211 long-term results double-door lamiplasty 203 lordotic curvature 189 magnetic resonance imaging 133 magnetic resonance imaging, thoracic spine 146 matrix vesicle calcification 98 mechanical compression of the spinal cord 104 mechanical stress 54 mechanism of spinal cord damage 67 metabolic and endocrilogical disorders 29, 33, 112 metabolic background of OPLL 40 microsatellite Getyping 20 microscopic findings of OPLL 43 midsagittal splitting lamiplasty 188 mixed-type, cervical OPLL 44, 117, 127, 179, 197 morbidity, OPLL 3 motoneuron 104 motor evoked potentials 151, 281 mouse model 101 multichannel monitoring 285 muscle relaxant 166 mushroom-shaped OPLL 132 myelography 135 myelography, thoracic spine 145 myelopathic intermittent claudication 123 myelopathy 34, 116, 134, 178 myotonic muscular dystrophy 116 natural course 177 natural course of myelopathy 117 neck pain 117 nerve root palsy 167, 221 nerve roots, tethering 190 neurological deterioration 228 neurological symptoms of OLF 122

7 Subject Index 305 neurological symptoms of OPLL 122 neurotrophic factors 105 neurotrophin 103, 104 nsteroidal antiinflammatory drugs (NSAID) 165, 166 occupying ratio 182, 299 occurrence and development of OPLL 29, 33 open-door procedure 188 operative technique, anterior floating method 210 ossification of ligamentum flavum (OLF) 49, 60, 121, 124, 138, 166, 227, 294 ossification of paraspinal ligaments 46 ossification of the posterior longitudinal ligament (OPLL) of thoracic spine 121, 124 ossification progression 13, 171 osteophytes 50 parametric linkage analysis 71 parathyroid hormone 38, 61 pathogenesis of OPLL 33 pathological process 182 pathology of ossification of the ligamentum flavum 52 pathology of spinal cord lesions 65 pedigree surveys 8 peripheral nerve stimulation 151 plain radiography of thoracic spine 145 poor surgical results 198 positional candidate gene analysis 22 positional cloning 19 posterior column 66 posterior decompression 182, 228, 294 posterior decompression procedures, thoracic OPLL 250 posterior longitudinal ligament 41 postoperative management 203, 245 post-operative motor paresis 205 postoperative neck/shoulder/arm pain 167 PPi metabolism 73 prevalence 11 procedure, lamiplasty 202 progsis 13, 14, 177, 220 progsis, myelopathy 233 progstic factors 221 progression, OPLL 137, 167, 169, 172, 175, 177, 183, 212, 213, 222, 247 proliferation of chondroblastic cells 44 proliferation of fibroblast-like cells 44 prostaglandin 61 prostaglandin E removal, OLF 275 roidism 29 segmental motor paralysis 197 segmental-type, OPLL 41, 127, 179, 197 sex hormones 39 sigmoid curvatures 189, 197 signal change in the spinal cord 134, 178 single nucleotide polymorphisms (SNPs) 20 skull traction 165 space available for the spinal cord (SAC) 14, 112, 117, 129, 166, 181, 299 spinal accessory motoneurons 102, 103, 105 spinal cord evoked potentials 151, 157 spinal cord stimulation 151, 157 spinal osteoblastoma 61 spondyloepiphyseal dysplasia 116 spondylotic spurs 43 square-type OPLL 132 surgical complications 166 surgical pathology 46 surgical technique, anterior decompression through the posterior approach 250 surgical technique, cervicothoracic lamiplasty 241 surgical technique, circumspinal decompression 235 surgical technique, lamiplasty 194 surgical treatment 166 symptom, cervical OPLL 111 symptom, OYL 111 thoracic kyphosis 228 thoracic myelopathy 122 thoracic OPLL 131 tiptoe walking (ttw) mouse 22, 71 tomography, thoracic spine 145 transcranial electrical stimulation 151, 284 transcranial magnetic stimulation 151 transcranial stimulation 281 transforming growth factor-β 55, 59, 61, 93 transsternal approach 231 transthoracic approach 231 triangular-shaped spinal cord 67 type VI collagen 24 vitamin A 29, 33 vitamin D 38 vitamin D-resistant hypophosphatemic rickets 30, 33, 39, 116 racial differences 29 radiculopathy 67, 116 radiographical classification, OPLL 111 radiography 127 rate of narrowing in the spinal canal 131 recombinant human BMP-2 94 removal, thoracic OPLL 274 waller degeneration of the spinal cord 69 white matter 65 wide laminectomy 166 Z-lamiplasty 201 zucker fatty rat 77