[目的]探讨后路单开门椎管成形术治疗颈椎联合上胸椎串联后纵韧带骨化症(ossification of posterior longitudinal lig-ament,OPLL)的临床效果.[方法]2015年5月-2019年2月对21例颈椎联合上胸段OPLL患者一期行单开门椎管成形手术治疗.[结果]所有病例均顺利完成手术,未出现脑脊液漏、硬膜外血肿等严重并发症.所有患者术后随访9～24个月.随时间推移,患者的锥体束征、JOA、VAS、NDI评分均显著改善(P＜0.05).其中1例患者出现较严重C5神经根麻痹症状,经对症处理后缓解.影像方面,与术前相比,术后6个月及末次随访时患者颈椎前凸角减小,但差异无统计学意义(P＞0.05),而椎管矢状径显著增加(P＜0.05).随访期间未出现再关门及门轴断裂等情况.[结论]后路单开门椎管扩大成形术治疗颈椎上胸椎串联后纵韧带骨化症可达到充分的脊髓减压,获得满意神经功能改善,并发症低,临床疗效满意.

Purpose: The study aimed to develop an evidence-based expert consensus statement on diagnosis and treatment of cervical ossification posterior longitudinal ligament (OPLL). Method: Delphi method was used to perform such survey, and the panel members from Asia Pacific Spine Society (APSS) 2020 were invited to answer the open-ended questions in rounds 1 and 2. Then the results were summarized and developed into a Likert-style questionnaire for voting in round 3, and the level of agreement was defined as 80%. In the whole process, we conducted a systematic literature search on evidence for each statement. Results: Cervical OPLL can cause various degrees of neurological symptoms, an it's thought to be more common in Asia population. CT reconstruction is an important imaging examination to assist diagnosis and guide surgical choice. Segmental, continuous, mixed, and focal type is the most widely used classification system. The non-surgical treatment is recommended for patients with no or mild clinical symptoms, or irreversible neurological damage, or failed surgical decompression, or condition cannot tolerant surgery, or refusing surgery. As OPLL may continue to develop gradually, surgical treatment would be considered in their course inevitably. The surgical choice should depend on various conditions, such as involved levels, thickness, and type of OPLL, skill-experiences of surgeons, which are listed and discussed in the article. Conclusion: In this statement, we describe the clinical features, classifications, and diagnostic criteria of cervical OPLL, and review various surgical methods (such as their indications, complications), and provide a guideline on their choice strategy.

目的 介绍一种治疗多节段严重胸椎后纵韧带骨化症的术式.方法 报道1例接受胸椎后路椎体骨化物复合体前移技术治疗的严重多节段胸椎后纵韧带骨化症病例,介绍手术步骤并分析临床资料.手术主要包括以下步骤:游离椎体骨化物复合体(前移节段上下椎间盘的松解、游离肋骨、放置椎板固定板、游离椎板)、置入椎弓根螺钉、安装钛棒、前移椎体骨化物复合体.结果 患者术后神经功能恢复良好,改良日本骨科协会评分(m-JOA)改善率为75％.手术耗时480 min,术中出血1 000 mL,术前测量椎管狭窄率为86.6％(T2/3)、68.2％(T4),术后椎管狭窄率降低为58.8％(T2/3,)和45.9％ (T4).结论 胸椎后路椎体骨化物复合体前移技术通过后方入路将椎体骨化物复合体进行游离,借助钉棒系统将椎体骨化物向腹侧推移,达到对脊髓的直接减压.该病例证明此技术治疗严重多节段胸樵后纵韧带骨化症具有可行性,且技术简单,操作均位于椎管外,无需切除骨化物,理论上减压操作安全有效,但该技术的临床效果仍需更多的临床研究加以验证.

Study Design. A cross-sectional study. Objective. The aim of this study was to investigate the prevalence of ossification of posterior longitudinal ligament (OPLL) in patients with degenerative cervical myelopathy (DCM). Summary of Background Data. OPLL of the cervical spine is one of the main entities of DCM in Asian populations. However, few studies have reported the prevalence of cervical OPLL in DCM patients. Methods. A total of 7210 DCM patients (4546 males and 2664 females; mean age: 54 years) who underwent cervical spine three-dimensional computed tomography (3D-CT) at the Shanghai Changzheng Hospital between January 2012 and December 2016 were included in this study. Demographic data including age, sex, height, body weight, body mass index (BMI), concomitant diabetes mellitus (DM), and hypertension were recorded. The imaging diagnosis criterion for OPLL was thickness >2 mm on axial imaging. Results. The overall prevalence of OPLL in the 7210 DCM patients was 18.22%, including 19.73% in males and 15.65% in females, with a significant difference between the two groups (P < 0.001). The prevalence of OPLL in DM and hypertensive patients was significantly higher than that in non-DM and normotensive patients (24.16% vs. 18.76% and 22.26% vs. 17.91%, both P < 0.001). Comparison by age and BMI showed that the prevalence of OPLL was the highest in the 70- to 79-year age group (21.91%) and obesity group (26.51%), respectively. Conclusion. This CT-based study revealed that the overall prevalence of OPLL in DCM patients was 18.22%. Furthermore, old age, male sex, comorbid hypertension or DM, and high BMI were risk factors for cervical OPLL. Given its high prevalence, CT examination is suggested to identify possible OPLL in DCM patients. Level of Evidence: 2

STUDY DESIGN:A prospective, randomized, controlled study.OBJECTIVE:To compare anterior controllable antidisplacement and fusion (ACAF) with laminoplasty in the treatment of multilevel ossification of the posterior longitudinal ligament (OPLL), and evaluate the efficacy and safety of this procedure.SUMMARY OF BACKGROUND DATA:The optimal approach for the treatment of OPLL still remains controversial. Both anterior and posterior approaches have their advantages and disadvantages.METHODS:Between September 2016 and April 2018, a total of 80 patients with multilevel OPLL were randomized in a 1:1 ratio to ACAF group and laminoplasty group. All patients were followed up at least 1 year. Clinical and radiological results were compared between ACAF group and laminoplasty group.RESULTS:ACAF took a longer operation time. C5 palsy and axial pain occurred more commonly in laminoplasty group, whereas dysphagia and hoarseness appeared easily in ACAF group. At 1-year follow-up, the final Japanese Orthopedic Association (JOA) score and recovery rate were significant higher in ACAF group than those in laminoplasty group, when occupying rate (OR) was not less than 60%, or K-line was negative. ACAF was also good at preservation of cervical lordosis and sagittal balance, but range of movement of cervical spine in both groups decreased significantly.CONCLUSION:Generally speaking, ACAF is a safe and effective alternative for multilevel OPLL. Compared with laminoplasty, ACAF is more effective in the cases when OR is not less than 60%, or K-line is negative.LEVEL OF EVIDENCE:2.

目的 探讨皮质骨通道(CBT)螺钉治疗腰椎融合术后邻椎病(ASD)的临床应用价值.方法 分析27例腰椎融合术后发生单节段ASD的患者资料,患者均行二次手术,两次手术间隔时间为4.0～8.6年.手术采用CBT螺钉固定结合椎间植骨融合技术.疼痛症状及神经功能恢复情况采用VAS评分和ODI评估,利用术后腰椎X线及CT检查评估内置物位置及植骨融合情况.结果 手术时间85～120 min,术中出血量180～400 ml.患者均获得随访,时间12～18个月.术后12个月,VAS评分和ODI均较术前明显改善,差异有统计学意义(P<0.05),随访过程中无并发症发生.结论 CBT螺钉治疗腰椎ASD患者手术创伤小,临床疗效满意.

OBJECTIVE:To evaluate safety and effectiveness of the application of piezosurgery in en bloc laminectomy for the treatment of multilevel thoracic ossification of ligamentum flavum (MTOLF). METHODS:Forty-one cases who had MTOLF and underwent en bloc laminectomy from January 2012 to January 2017 were reviewed and divided into Group A (high-speed drill, n = 23) and Group B (piezosurgery, n = 18). Comparisons in clinical outcome and perioperative complications were carried out between the 2 groups. RESULTS:Mean follow-up period was comparable between Group A (12.6 months) and Group B (11.4 months). Both operation time and intraoperative blood loss in Group A were significantly more than those in Group B (P < 0). Although final Japanese Orthopaedic Association (JOA) score in both groups significantly increased, differences in preoperative JOA, final JOA, and neurologic recovery rate between the 2 groups weren't significant. Perioperative complications included early neurologic deterioration (1 in Group A), wound infection (2 in Group A and 1 in Group B), and leakage of cerebrospinal fluid (5 in Group A and 1 in Group B); incidences of these complications between the 2 groups weren't significant (P > 0.05). A relationship analysis showed that cases with preoperative tram track sign, tuberous OLF, or larger compression ratio were at greater risk of developing an intraoperative dura defect. CONCLUSIONS:The application of piezosurgery in en bloc laminectomy is a safe and effective method in the treatment of MTOLF, and it was advantageous for reducing both operation time and intraoperative blood loss compared with the high-speed drill.

目的 探讨全身麻醉下手法牵引复位联合颈前路减压植骨融合内固定术治疗颈椎骨折脱位的疗效.方法 回顾性分析自2015-01-2016-01诊治的62例颈椎骨折脱位,在全身麻醉下行手法牵引复位,复位时需要注意牵引的方向和牵引的力度,颈椎骨折脱位复位满意后尽量选择行一期颈椎前路椎间盘切除减压植骨融合内固定术.结果 本组手术时间平均92(78～120)min,术中出血量平均80(50～300)ml.术后切口均一期愈合,均未发现切口感染.10例需要气管切开并转入ICU监护.术后8例出现不同程度腹胀,5例出现低蛋白血症,5例吞咽困难,均对症处理.62例均获得随访,随访时间平均18(12～24)个月.随访期间影像学检查显示椎间融合率达到100％,无假关节形成.末次随访时ASIA评分:A级5例,B级18例,C级10例,D级20例,E级9例.结论 全身麻醉下手法牵引复位可提高颈椎骨折脱位复位成功率,复位后再行颈前路减压植骨融合内固定术,可缩短手术时间、简化手术方式,并且不会加重脊髓损伤.

Long non-coding RNAs (lncRNAs) play an important role in the development of bone-related diseases. This study was conducted to investigate the role and mechanism of lncRNA X inactive specific transcript (XIST) in the occurrence of cervical ossification of the posterior longitudinal ligament (OPLL). Here, primary human ligament fibroblasts cells (LFCs) were isolated from 30 cases of OPLL and 30 normal cervical posterior longitudinal ligament (non-OPLL) tissues to perform the qPCR and Western blot assay. We found that the mRNA level of lncRNA XIST was significantly increased in OPLL LFCs compared to non-OPLL LFCs. By bioinformatics analysis, we found that lncRNA XIST has four binding sites for miR-17-5p and found that the mRNA level of miR-17-5p was also significantly decreased in OPLL LFCs compared to non-OPLL LFCs. Since AHNAK is the target gene of miR-17-5p, we further found that the expression of AHNAK was significantly reduced in non-OPLL LFCs after being transfected with miR-17-5p mimic. The qPCR results showed that the mRNA expressions of BMP2 and Runx2 were significantly decreased. After being transfected with lncRNA XIST siRNA in the non-OPLL LFCs, the mRNA levels of lncRNA XIST, AHNAK, BMP2, and Runx2 were significantly decreased and the phosphorylated protein of Smad1/5/8 was reduced. After being cultured by mechanical vibration, the mRNA levels of lncRNA XIST, AHNAK, BMP2, Runx2, COL1, OC, OPN, and Phospho1 were significantly increased, but the mRNA expression of miR-17-5p was significantly decreased. The expression of phosphorylated Smad1/5/8 protein was also significantly increased. Together, this study was the first to determine that XIST gene inhibition plays an important role in the occurrence of cervical OPLL, through the mechanism of regulation of miR-17-5P/AHNAK/BMP2 signaling pathway. Thus, XIST may be a potential target that could be modulated for the treatment of cervical OPLL.

BACKGROUND: To evaluate effectiveness and safety of extended laminoplasty for the treatment of ossification of posterior longitudinal ligament (OPLL) involving the C2 segment. METHODS: A total of 132 cases who accepted laminoplasty for treating the OPLL from 2010 to 2015 were included and divided into Group A (n = 26, with C2 OPLL and C2-C7 laminoplasty), Group B (n = 29, with C2 OPLL and C3-C7 laminoplasty), and Group C (n = 77, without C2 OPLL and had C3-C7 laminoplasty). Clinical and radiologic outcomes were compared among the 3 groups. RESULTS: At the final visit, significant improvements in japanese Orthopedic Association score, Neck Disability Index, Health-Related Quality-of-Life Short Form 36 Physical Component Summary, and Visual Analog Scale score in neck were observed in all 3 groups. However, all the C2-C7 Cobb angle, C2-C3 Cobb angle, sagittal vertical axis, and number of cases with cervical or segmental kyphosis in the 3 groups were not significantly changed. Although total blood loss, operation time, maximum Visual Analog Scale score in neck, incidence of axial pain, change of C2-C7, or sagittal vertical axis in Group A were all significantly larger than that in Group B or Group C, differences in neurologic recovery rate, Neck Disability Index, Health-Related Quality-of-Life Short Form 36 Physical Component Summary, change of the C2-C3 Cobb angle, and incidence of cervical or segmental malalignment among the 3 groups were not significant at the final visit. CONCLUSIONS: If decompression indication for cases with OPLL involving the C2 segment was appropriate, extended laminoplasty up to the C2 segment could provide satisfactory neurologic recovery and would not accelerate cervical or segmental malalignment progression.

Ossification of the posterior longitudinal ligament (OPLL) is the major cause for several deteriorate bone and joint diseases. Its development is a highly organized dynamic process as modulated by various physiological and pathophysiological factors. Both long non-coding RNAs (lncRNAs) and small non-coding RNAs (miRNAs) have been postulated to involve into almost all the biological conditions. Here, we applied high through-put transcriptome screening to unveil lncRNAs highly regulated under OPLL condition. siRNA assay in combination with western blot and quantitative PCR deciphered the lncRNA and miRNA functions in OPLL and their underlying mechanism. Here we identified an lncRNA, named Metastasis Associated Lung Adenocarcinoma Transcript 1 (MALAT1) engaged into the development of OPLL by indirectly targeting Connexin 43 (Cx43) gene. As previously reported, Cx43 is one of the main proteins contributing to OPLL partially through enhancing inflammatory signaling. On top of that, we provided another regulatory layer that MALAT1 served as the upstream effector governing the transcription of Cx43 gene. Perturbation of MALAT1 significantly inhibited Cx43 expression, inflammation, and osteogenesis. Mechanistically, in silico analysis and experimental validation both confirmed that microRNA-1 (miR-1) was the mediator connecting MALAT1-Cx43 axis: overexpression of miR-1 diminished Cx43 expression and OPLL process; meanwhile, MALAT1 acted as miR-1 sponge to inhibit its suppressive transcription effect on downstream ossification related genes. Knock-down of MALAT1 released sequestered miR-1, which repressed Cx43 expression and associated OPLL. Likewise, induced OPLL caused by overexpression of MALAT1 can be ameliorated by enhanced miR-1 function, knock-down of Cx43 or inhibition of inflammation. More importantly, further validation using patient ligament samples from non-OPLL and OPLL individuals identified MALAT1-miR-1-Cx43 regulatory axis. Collectively, we found a novel mechanism through lncRNA-miRNA interaction that provides more insights into understanding the development of OPLL.

Objective:To observe the clinical effect of posterior Hybrid technique in the treatment of cervical mixed type ossification of posterior longitudinal ligament.Method:The clinical data of 8 patients with mixed ossification of posterior longitudinal ligament of cervical spine treated by posterior Hybrid technique in our hospital from March 2015 to July 2017 were retrospectively analyzed.The operation time, intraoperative bleeding volume, fixed segment, visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) neurological function scores, neurological function improvement rate (RIS) and complications were recorded.Result:All patients were successfully operated, the operation time was ranging from 118 min to 182 min, the average was142.88 min;the intraoperative bleeding volume was ranging from 250 to 400 mL, the average was 325.00 mL.No complications such as spinal cord injury or cerebrospinal fluid leakage occurred during operation.1 cases patient was complicated with C5 nerve paralysis symptoms, which alleviated after 2 weeks of hormone and neurotrophic therapy, the symptoms disappeared.All patients wound were healing best and followed up for 6 to 9 months, the average was 7 months.The preoperative VAS score of neck was ranging from 7 to 9 scores, and the last follow-up VAS score was improved by 0 to 2 scores.The JOA score improved to different degrees, which was improved from8 to 12 scores (average 10.25 scores) before operation to 13 to 16 scores (average 15.13 scores) during the last follow-up.The neurological function improvement rate was ranging from 44.44％to 85.71％ (average 72.13％), of which 5 cases were excellent, 2 cases were good and 1 case was fair.No door-reclose was noted during the last follow-up.Conclusion:Cervical posterior Hybrid technique in the treatment of cervical mixed type ossification of posterior longitudinal ligament is safe and simple, with fewer complications and clinical effect is satisfactory.

Ossification of the posterior longitudinal ligament (OPLL) manifests as ectopic bone formation in spinal ligament tissue. As revealed by in vitro studies, fibroblasts from patients with OPLL or healthy ligament fibroblasts undergo mechanical stress (MS). We previously demonstrated that a cell-cell junction protein, connexin 43 (Cx43), is significantly up-regulated in OPLL cells and previous data indicated that some proteins related to the endoplasmic reticulum (ER) stress response are elevated during the development of OPLL. The present study utilized gain- and loss-of-function tools to delineate the contribution of the ER stress response within ligament fibroblasts under OPLL-inducing stimuli and the crosstalk between Cx43 signaling and the ER stress response. The ER stress process was augmented by the induction of Cx43 expression in OPLL cells or cells under MS. Cx43 over-expression also promoted ER stress and ossification in OPLL cells. Moreover, the activation of ER stress was accompanied with increased oxidative stress, which was inhibited by Cx43 gene silencing. Cx43 knockdown also improved ER stress-related ossification in OPLL cells. The blockage of ER stress using a chemical compound or small interfering RNA was sufficient to overcome MS-induced ossification in OPLL cells. These findings were further validated in patients with OPLL, as the mRNA levels of Cx43 and PKR-like endoplasmic reticulum kinase (a single-pass type I ER membrane protein kinase), a major transducer of ER stress, were significantly increased compared with non-OPLL subjects. In conclusion, this study demonstrates that ER stress participates in Cx43-related OPLL.

The pathogenesis of ossification of posterior longitudinal ligament (OPLL) is not completely clear. Previous study has confirmed a single-pass type I endoplasmic reticulum (ER) membrane protein kinase (PERK), which is a major transducer of the ER stress, participates in the process of OPLL in vitro. This study aimed to demonstrate the role of ER stress in mechanical stress (MS)-induced OPLL. The posterior longitudinal ligaments were collected intraoperatively. The expression of ER stress markers in ligament tissue samples was compared between OPLL and non-OPLL patients in vivo. Ligament fibroblasts were isolated and cultured. Loaded by MS, the expression of ER stress markers in fibroblasts deriving from non-ossified areas of the ligament tissues from OPLL patients was detected. The influence of inhibition of ER stress on MS-induced OPLL and activation of mitogen-activated protein kinase (MAPK) pathways by MS was also investigated. We confirmed the ER stress markers were highly expressed in non-ossified areas of the ligament tissues from OPLL patients but could barely be detected in the ligaments from non-OPLL patients in vivo. We also found ER stress could be activated by MS during the process of OPLL in vitro. Moreover, inhibition of ER stress could hinder MS-induced OPLL and activation of MAPK signaling pathways by MS in vitro. Activated ER stress was observed in OPLL patients both in vitro and in vivo. Mechanical stress could activate ER stress response in posterior longitudinal ligament fibroblasts and further promote OPLL in vitro. In this process, ER stress might work through the MAPK signaling pathways. These slides can be retrieved under Electronic Supplementary Material.

Objective To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) for the treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.Methods The data of 45 cases with cervical posterior longitudinal ligament ossification treated by ACAF from March 2017 to October 2017 were retrospectively analyzed,including 25 males and 20 females,age 45-68 years,average 57.5 years.There were 18 cases involving C3 vertebral body,30 cases involving C4 vertebral body,40 cases involving C5 vertebral body,34 cases involving C6 vertebral body,and 7 cases involving C7 vertebral body.The function of the neural function was evaluated by the Japanese Orthopaedic Association (JOA) scoring system at preoperation and latest follow-up.The curvature of the cervical spine was measured on the lateral X-ray film of the cervical spine,the maximum occupying ratio of the spinal canal was measured on the cross section of the CT scan,and compression of the cervical spinal cord was evaluated by the cervical MRI.Results Patients were followed up for 3 to 6 months (average,3.9 months).The improvement of neurological function was obtained in all the patients.The JOA score improvement rate at the latest follow-up was 71.3％±9.6％.The cervical lordosis was improved from preoperative 4.5°±3.8° to 10.3°±4.8° at the latest follow-up.The canal stenosis ratio was decreased from preoperative 54.3％±8.2％ to 12.5％±5.3％ at the latest follow-up.MRI showed that the cervical spinal cord was adequately decompressed in situ.No specific complications were identified that were associated with this technique.Conclusion The present study elaborates the surgical tips and demonstrates the satisfactory outcome of ACAF for the treatment of OPLL.This novel technique has the potential to serve as an alternative surgical technique for the treatment of cervical OPLL.

PURPOSE:A 62-year-old blind man with severe ossification of the posterior longitudinal ligament was presented. The patient underwent posterior laminectomy and fixation. After surgery, the patient was not satisfied with the recovery of his upper limbs although his Japanese Orthopedic Association (JOA) score had increased from 9 to 12 points. Because the tactile sensation of his hands was especially important to his daily life, the patient asked for further treatment after 6 months. This report describes the novel revision surgery we invented and the outcome in the patient after the surgery.METHODS:We performed the revision surgery using an anterior approach from C3 to C7 with a novel technique, anterior controllable antedisplacement and fusion (ACAF). The patient was followed up for 6 months. The clinical data, including JOA score and radiologic images, were collected and analyzed.RESULTS:After the revision surgery, the patient had improved sensation in both hands, and his JOA score increased to 14 points. Satisfactory decompression was assessed by magnetic resonance imaging after operation. Bone fusion was confirmed by computed tomography 3 months after operation. No specific complications related to this surgery were observed.CONCLUSIONS:The application of such an operative procedure in revision surgery for OPLL has not been reported earlier and might be an alternative choice for patients with an unsatisfactory outcome from previous posterior surgery.

目的 探讨颈椎后路单开门椎管扩大成形术与颈椎后路椎板切除减压椎弓根钉内固定术治疗颈椎后纵韧带骨化症并发C5神经根麻痹的影响因素,并总结预防和治疗经验.方法 回顾性分析自2011-06-2014-06诊治的83例颈椎后纵韧带骨化症,43例行颈后路单开门椎管扩大微型钛板成形术(A组),40例行颈后路椎板切除减压椎弓根钉内固定术(B组).比较2组术前及末次随访时JOA评分,以及C5神经根麻痹发生率.结果 术后1～3 d内共出现8例(9.6％)C5神经根麻痹,其中A组出现2例(4.7％),B组出现6例(15.0％);A组术后C5神经根麻痹发生率低于B组,差异有统计学意义(P＜0.05).8例C5神经根麻痹患者采用甘露醇脱水及地塞米松治疗,进行积极功能锻炼,症状得到缓解;2例遗留肩部疼痛及关节活动受限,在全身麻醉下行肩关节松解术.2组末次随访时JOA评分较术前明显提高,差异有统计学意义(P＜0.05).结论 颈椎后路单开门椎管扩大成形术和椎板切除减压椎弓根钉内固定术治疗颈椎后纵韧带骨化症均能获得有效的神经功能恢复,但颈椎后路椎板切除减压椎弓根钉内固定术后并发C5神经根麻痹的概率更高,因此需在围手术期进行合理预防和治疗以降低术后C5神经根麻痹的发生率及其严重程度.

BACKGROUND: Cervical spondylotic amyotrophy (CSA) is not common. The clinical features and long-term surgical outcomes of patients with CSA are also unclear. We sought to summarize clinical features, assess long-term surgical outcomes, and determine the prognostic factors relevant for patients with CSA. METHODS: A total of 136 patients with CSA who underwent anterior or posterior decompression during January 2001 to December 2012 were included. Their clinical and radiologic data were collected. The surgical outcome was evaluated using manual muscle test and improvements in the muscle strength. Correlations between the surgical outcome and various factors also were analyzed. RESULTS: In total, 128 patients underwent anterior decompression and 8 patients underwent posterior decompression. At the final follow-up, the surgical outcome was significantly better after anterior decompression compared with that after posterior decompression. Statistical analyses showed the type of CSA, duration of symptoms, and association with ossification of the posterior longitudinal ligament were associated with a poor outcome after anterior surgery (P < 0.05). CONCLUSIONS: Besides significant muscular atrophy in one upper extremity, CSA also occasionally presents with mild atrophy in the other upper extremity, sensory disturbance in the upper extremities, or hyperflexia in the lower extremities. Anterior decompression is generally effective in the treatment of patients with CSA. Preoperative duration of symptoms, type of CSA, and ossification of the posterior longitudinal ligament are important predictors for the surgical outcome.

部分临床医学研究生存在与患者沟通的障碍,不少问题根植于"语商"的不足.通过分析研究生存在的语言特征及问题,指出目前医学教育中人文沟通课程的现状和缺陷,提出集中教育和小组教育、翻转课堂和专家授课、全程监督和定期考核、深入社区和医院实践四个结合的应对措施,以提高研究生的"语商",减少医患沟通矛盾.

BACKGROUND:Ankylosing spondylitis (AS) is classified as a chronic inflammatory seronegative rheumatic arthritis. Patients with AS are more likely to sustain a fracture of the cervical spine compared with the general population. Most fractures occur in the lower cervical spine and manifest at the level of the intervertebral disc. There have been few reports about the surgical treatment for upper cervical spine fractures in patients with AS, especially odontoid fractures. We present 3 cases of odontoid fracture in patients with long-standing AS.METHODS:Odontoid fracture with atlantoaxial displacement was identified on radiologic imaging in 3 patients. In 1 patient, fracture was a missed diagnosis after initial trauma, and the fracture and displacement were discovered 3 months later owing to aggravation of symptoms. Posterior occipitocervical fusion with iliac autograft was performed under general anesthesia in all cases.RESULTS:All 3 patients recovered postoperatively without any complications related to surgery. Cervical radiographs obtained at 12-month follow-up demonstrated healed fracture and replacement of the atlantoaxial joint.CONCLUSIONS:Odontoid fracture with atlantoaxial dislocation in patients with long-standing AS is uncommon. Clinicians must be cautious in assessing such patients with any episode of trauma. Computed tomography and magnetic resonance imaging can be helpful in demonstrating occult odontoid fractures. Posterior occipitocervical fusion with internal fixation may benefit these patients, although at the cost of sacrificing the last motion segment.