Posterior longitudinal ligament ossifikasyonu (OPLL)

Özet

OPLL, posterior longitudinal ligament dokusunun vertebra korpuslarının arkasında kemikleşerek spinal kanala doğru uzanmasıdır; en sık servikal omurgada tanınır. BT ve MR, OPLL’nin yayılımını, şeklini, kalınlığını ve yerleşimini değerlendirmede kullanılabilir; BT uzunluk ve kalınlığı en doğru biçimde gösterirken MR omurilikteki sinyal değişikliklerini değerlendirmede avantaj sağlar. Dar kanal kord basısını düşündürse de BT kord dokusunu, ödemi veya miyelomalaziyi güvenilir biçimde değerlendiremez; nörolojik bulgular için MR gerekir. OPLL’nin kanal içindeki uzanımı BT’de değerlendirilir; çift tabaka işareti olası dural defekti düşündürür.

Faz ve pencere

Kontrastsız tanısal

OPLL kemikleşmesinin değerlendirilmesinde BT’nin kemik penceresi kullanılır. Aksiyel görüntüde korpus arka korteksine paralel yüksek dansiteli plak veya nodüler kemikleşme kanalın ön konturuna kabarır; sagittal MPR'de ossifikasyonun korpus ve disk düzeylerine göre yayılımı belirlenir.

Kemik algoritması tanısal

İnce kesit aksiyel ve sagittal rekonstrüksiyonlar ossifikasyonun kanal içindeki kalınlığını, santral/lateral konumunu ve devamlılığını gösterir. Korpus arka korteksinden ayrılan çift yoğunluk çizgisi olası dural ossifikasyon için ipucudur; kordun gerçek basısı ve sinyal değişikliği bu BT fazıyla saptanamaz.

Önerilen pencereler: Kemik (G 1800 / M 400).

BT bulguları

• Korpus arka yüzüne paralel plak — posterior longitudinal ligament hattında kemik dansitesinde bant, spinal kanalın ön bölümüne taşar.
• Segmental ossifikasyon — ayrı vertebra korpuslarının arkasında kesintili kemik odakları görülür.
• Sürekli ossifikasyon — kemikleşme birden fazla korpus ve aradaki disk düzeyini kesintisiz geçer.
• Karma örüntü — devamlı plak bölümleri ile aralıklı segmental odaklar aynı omurga boyunca birlikte bulunur.
• Lokalize/diğer örüntü — ossifikasyon sınırlı bir disk veya vertebra düzeyinde kalabilir; morfoloji sagittal ve aksiyel planda tariflenir.
• Kanal ön-arka çapında daralma — kemik konturun kanal içine en fazla kabardığı seviye belirtilir; kemik oranı kord basısının yerine geçmez.
• Çift tabaka işareti — ossifiye ligamentin ardında düşük dansiteli çizgiyle ayrılan ikinci kemik yoğunluğu olası dural ossifikasyonu düşündürür.

Ölçütler ve sınıflamalar

Japon Sağlık ve Refah Bakanlığı morfolojik sınıflaması

Sürekli: ossifikasyon çok sayıda korpus ve disk aralığını köprüler. Segmental: ayrı korpusların arkasında odaklar bulunur. Karma: sürekli ve segmental bileşenler birliktedir. Lokalize/diğer: çoğunlukla disk düzeyinde sınırlı ossifikasyon örüntüsüdür.

Normalde

Normal servikal düzeyde vertebra korpuslarının arka korteksi ince ve düzgün bir çizgi oluşturur; spinal kanalın ön sınırında kord önünde ossifiye plak bulunmaz. OPLL’yi sınıflandırırken sagittal BT kesitlerinde seviyeler boyunca yayılımı, aksiyel kesitlerde lezyonun santral veya parasentral yerleşimini değerlendirin.

Ayırıcı tanı

Posterior vertebral osteofit ile OPLL ayrımında, OPLL’nin vertebra korpusları ve disk aralıklarıyla ilişkisi BT’de değerlendirilir.

Kalsifiye disk hernisi

disk aralığı merkezli, fokal ve çoğu kez posteriora uzanan kalsifik materyaldir; korpus arka yüzleri boyunca çok seviyeli bant yapmaz.

Hipertrofik posterior longitudinal ligament

yumuşak doku kalınlaşması kemik yoğunluğunda olmayabilir; küçük noktasal ossifikasyon odakları erken OPLL ile karışabilir.

Ossifiye ligamentum flavum, posterior longitudinal ligament ossifikasyonundan (OPLL) ayrı bir spinal ligament ossifikasyonudur.

Dural kalsifikasyon

spinal kanal içinde ligament hattından farklı konumda olabilir; tek kesitteki yoğunluk yerine korpusla ve durayla ilişkisi MPR'de değerlendirilir.

Tuzaklar

• Osteofit ve disk protrüzyonu OPLL gibi kanal önüne kabarabilir; aksiyel kesitte kemikleşmenin vertebra korpusunun arka yüzüne paralel devamlılığını ve disk seviyeleriyle ilişkisini izleyin.
• MR'da posterior spur veya kalınlaşmış ligament OPLL izlenimi verebilir; kemikleşmenin kesin gösterimi ve sınıflaması için BT kemik penceresine dönün.
• Dar kanal çapını kordun gerçek basısı olarak sunmayın; BT kemik alanını gösterir, kord şekli ve intramedüller sinyal için MR gerekir.
• Çift tabaka işareti dural ossifikasyonla ilişkili olabilir ancak tek başına dural penetrasyonu kesinleştirmez; ince kesit aksiyel görüntü ve cerrahi bağlamla dikkatli tarif edin.

Kendini dene

1. Servikal BT'de korpusların arka yüzüne paralel kemik plak kanalın ön konturuna taşıyor; sagittal planda bazı segmentler kesintili. En uygun adlandırma hangisidir?

   • Segmental OPLL
   • Ossifiye ligamentum flavum
   • Kalsifiye disk hernisi
   • Posterior osteofit
   Cevabı göster

   Segmental OPLL. Korpus arkasındaki ligament hattında kesintili kemikleşme segmental OPLL morfolojisidir. Ligamentum flavum kanalın arka tarafındadır; kalsifiye disk disk merkezlidir; osteofit son plak kenarından çıkar.

2. OPLL plağı kanalı daraltıyor ve hastada el becerisi kaybı var. Kordun şekli ve iç sinyal değişikliğini hangi inceleme gösterir?

   • Servikal MR
   • Kontrastsız BT
   • Direkt grafi
   • Kemik sintigrafisi
   Cevabı göster

   Servikal MR. MR kord konturunu ve intramedüller sinyali değerlendirir. BT, ossifikasyonun uzunluğunu ve kalınlığını en doğru biçimde gösterirken; MR, kord basısı ve intramedüller sinyal değişikliklerini değerlendirmeyi sağlar.

İlgili konular

• Ligamentum flavum ossifikasyonu (OLF)

Kaynaklar

Bu sayfadaki 45 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 7 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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