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Spinal ossification is a condition in which the ligaments located in the spine become hard and thickened like bones.
It's easy to think of it as bone growth. This thickening of the bones causes the nerves to be compressed, which eventually leads to nerve damage and motor paralysis. It causes severe symptoms such as inability to move legs and walk.
Spinal ossification is not as common as lumbar stenosis, but it is not as low in incidence.
The ligament in the front of the spine is the anterior longitudinal ligament, and the posterior longitudinal ligament is the posterior longitudinal ligament. And in terms of the spinal canal, the posterior is the posterior arch, and the ligament that connects between the concubines is called the yellow ligament. Yellow ligament ossification is a disease that usually causes problems in thoracic vertebrae 10~12.
The central nervous system descends through the spinal canal, with the posterior longitudinal ligament at the front of the spinal canal and the yellow ligament at the top. If the posterior longitudinal ligament grows bone, it will press the spinal nerves from front to back, and if the yellow ligament has ossification, it will press from back to front.
First, the cause of posterior longitudinal ligament ossification
Second, the cause of sacroiliac ligament ossification
Yellow ligament ossification is also caused by genetic factors, but it can also be caused by repetitive and mechanical stimuli.
Both diseases are distributed in East Asia, including Korea, Japan, and China, and have a lower incidence in Western countries. The prevalence rate in South Korea was statistically estimated at 4.6%. In addition, the prevalence is higher in males than in females, and the age of prevalence is over 40s.
First, clinical symptoms of posterior longitudinal ligament ossification
Osification of the posterior longitudinal ligament is asymptomatic. In some cases, there are no symptoms and then trauma triggers symptoms suddenly.
Symptoms include myelopathy* symptoms such as fine hand movements, difficulty walking, sexual function and defecation disorders, neuromuscular compression symptoms such as neck pain, upper limb pain and paresthesia, and symptoms of transspinal paralysis such as quadriplegia, upper and lower limb abnormal sensation, perceptual disturbances, and difficulty urinating.
Second, clinical symptoms of xenosis of the sacroiliac band
When the xenoligament ossification, it causes an unsteady gait. This makes it difficult to climb stairs, and in severe cases, you may have to walk on flat roads with a cane. Acute myelopathy caused by minor trauma can also occur, which is severe and has a poor prognosis.
Spinal ossification is diagnosed by radiological examination.
MRI scans are usually used, but severe cases can also be detected by X-rays. CT and MRI are much easier to diagnose ossification. The reason is that spinal cord compression, bleeding, edema, atrophy can be observed. In this way, after observation, the surgical method can be selected and the prognosis can be estimated.
If there is ossification, surgery is not guaranteed. Mild cases that do not interfere with daily life are checked for conservative treatment.
If neurological symptoms continue to progress, recurrent paralysis, pain without conservative treatment, or myelopathy, decompression treatment is performed surgically. Even if you do not have any of the symptoms listed above, surgery may be performed if there are signs of signal changes in the spinal cord on MRI or if there is compression of the spinal cord.
In the case of severe myelopathy immediately after trauma, emergency spinal cord decompression is performed to prevent irreversible damage to the spinal cord.
Surgery for spinal ossification is divided into two types depending on the approach.
First, the forward approach
The anterior approach, which is a forward-facing surgical approach, is used for most segmental and focal ossifications.
After removal of the vertebral body* or removal of the intervertebral disc*, the ossified lesion is completely removed and the anterior intervertebral osseofusion is performed. Since the lesion is fundamentally removed, the recurrence rate is low.
*Vertebral body: The part of the vertebrae that resembles a piece of elliptical column that supports the weight of the body at the front of the vertebrae.
*Intervertebral discs: Strong connective tissues that connect the vertebrae
Second, the rear approach
If ossified lesions such as continuous or mixed type are invaded over multiple segments, surgery is performed with a posterior approach.
Posterior approaches include laminectomy or laminetomy. Plastic surgery is a surgical procedure in which the bones of the spine are reshaped so that they no longer press on the nerves, and resection is a surgical procedure in which all the bone is removed and a nail is inserted. The most common surgical procedure is laminetoplasty.
It is more important whether the bone grows from side to side than it does from top to bottom. The reason for this is that if it grows on both sides, it can press on the nerves again.
There are studies on this. In a 10-year postoperative follow-up of 64 patients, the bones of the spine thickened by an average of 0.3 mm per year and lengthened by 1 mm. In addition, the degree of growth was higher in the younger the age and the mixed and continuous type. The result of plastic surgery was greater than that of resection.
There are many arguments about the need for preventive surgery. Even in mild cases, if the neurosis is too severe, if there is radiating pain, neck pain, or damage to the spinal nerves on the MRI, it is dangerous to postpone surgery if there are no symptoms, so you should weigh the benefits and risks when deciding on surgery.
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