{"title":"枕外隆突增生的性别特异性模式：与脊髓病患者颈韧带骨化和颈椎矢状位失衡有关。","authors":"Zhaoyang Gong, Hanqiu Sun, Dachuan Li, Xiao Lu, Siyang Liu, Ximeng Wang, Xinlei Xia, Feizhou Lyu, Jianyuan Jiang, Fei Zou, Hongli Wang, Xiaosheng Ma","doi":"10.31616/asj.2025.0109","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cross-sectional analysis of 187 consecutive patients undergoing surgical treatment for cervical spondylotic myelopathy (CSM).</p><p><strong>Purpose: </strong>To investigate sexual dimorphism in external occipital protuberance (EOP) hyperplasia morphology and elucidate its clinical correlation with ossification of the nuchal ligament (ONL) and cervical sagittal imbalance.</p><p><strong>Overview of literature: </strong>Emerging evidence implicates EOP hyperplasia as potential biomarker of chronic neck strain, yet its relationship with ONL and cervical sagittal imbalance remains underexplored in surgical CSM cohorts.</p><p><strong>Methods: </strong>Cervical radiographs were analyzed. EOP hyperplasia was classified into three subtypes with standardized length measurements. Variables encompassed demographics, ONL-related indices, and sagittal parameters. Subtype comparisons and multivariate regression analyses (with EOP length as dependent variable) were conducted.</p><p><strong>Results: </strong>Analysis of 187 CSM patients (64.2% male) identified gender-specific patterns: males exhibited greater EOP length (9.4±6.8 mm vs. 4.6±3.4 mm, p<0.001). Type III EOP demonstrated male predominance (82.4% vs. type I 31.8%, type II 51.4%; p<0.001), with associated longer hyperplasia length (11.6±6.6 mm vs. type II 5.1±1.9 mm, p<0.001). Type III EOP was associated with higher ONL prevalence (type III 64.8% vs. type I 45.5%, type II 41.9%; p=0.010) and longer ONL osteophyte length (type III 18.8±9.8 mm vs. type I 14.2±8.1 mm, type II 14.2±9.4 mm; p=0.046). Multivariate regression confirmed male sex (β=-3.82, p=0.009), ONL osteophyte length (β=0.16, p=0.017), T1 slope (β=0.27, p=0.041), and spino-cranial angle (β=-0.19, p=0.009) as factors independently associated with EOP length (adjusted R²=0.382).</p><p><strong>Conclusions: </strong>Severe EOP hyperplasia exhibits a male-predominant distribution pattern and demonstrates significant radiological associations with ONL and cervical sagittal imbalance in CSM patients. These findings advocate for EOP evaluation in clinical evaluations to identify high-risk biomechanical profiles.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Gender-specific patterns of external occipital protuberance hyperplasia: associations with nuchal ligament ossification and cervical sagittal imbalance in myelopathy patients.\",\"authors\":\"Zhaoyang Gong, Hanqiu Sun, Dachuan Li, Xiao Lu, Siyang Liu, Ximeng Wang, Xinlei Xia, Feizhou Lyu, Jianyuan Jiang, Fei Zou, Hongli Wang, Xiaosheng Ma\",\"doi\":\"10.31616/asj.2025.0109\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cross-sectional analysis of 187 consecutive patients undergoing surgical treatment for cervical spondylotic myelopathy (CSM).</p><p><strong>Purpose: </strong>To investigate sexual dimorphism in external occipital protuberance (EOP) hyperplasia morphology and elucidate its clinical correlation with ossification of the nuchal ligament (ONL) and cervical sagittal imbalance.</p><p><strong>Overview of literature: </strong>Emerging evidence implicates EOP hyperplasia as potential biomarker of chronic neck strain, yet its relationship with ONL and cervical sagittal imbalance remains underexplored in surgical CSM cohorts.</p><p><strong>Methods: </strong>Cervical radiographs were analyzed. EOP hyperplasia was classified into three subtypes with standardized length measurements. Variables encompassed demographics, ONL-related indices, and sagittal parameters. Subtype comparisons and multivariate regression analyses (with EOP length as dependent variable) were conducted.</p><p><strong>Results: </strong>Analysis of 187 CSM patients (64.2% male) identified gender-specific patterns: males exhibited greater EOP length (9.4±6.8 mm vs. 4.6±3.4 mm, p<0.001). Type III EOP demonstrated male predominance (82.4% vs. type I 31.8%, type II 51.4%; p<0.001), with associated longer hyperplasia length (11.6±6.6 mm vs. type II 5.1±1.9 mm, p<0.001). Type III EOP was associated with higher ONL prevalence (type III 64.8% vs. type I 45.5%, type II 41.9%; p=0.010) and longer ONL osteophyte length (type III 18.8±9.8 mm vs. type I 14.2±8.1 mm, type II 14.2±9.4 mm; p=0.046). Multivariate regression confirmed male sex (β=-3.82, p=0.009), ONL osteophyte length (β=0.16, p=0.017), T1 slope (β=0.27, p=0.041), and spino-cranial angle (β=-0.19, p=0.009) as factors independently associated with EOP length (adjusted R²=0.382).</p><p><strong>Conclusions: </strong>Severe EOP hyperplasia exhibits a male-predominant distribution pattern and demonstrates significant radiological associations with ONL and cervical sagittal imbalance in CSM patients. These findings advocate for EOP evaluation in clinical evaluations to identify high-risk biomechanical profiles.</p>\",\"PeriodicalId\":8555,\"journal\":{\"name\":\"Asian Spine Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-08-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Spine Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.31616/asj.2025.0109\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Spine Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31616/asj.2025.0109","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Gender-specific patterns of external occipital protuberance hyperplasia: associations with nuchal ligament ossification and cervical sagittal imbalance in myelopathy patients.
Study design: Retrospective cross-sectional analysis of 187 consecutive patients undergoing surgical treatment for cervical spondylotic myelopathy (CSM).
Purpose: To investigate sexual dimorphism in external occipital protuberance (EOP) hyperplasia morphology and elucidate its clinical correlation with ossification of the nuchal ligament (ONL) and cervical sagittal imbalance.
Overview of literature: Emerging evidence implicates EOP hyperplasia as potential biomarker of chronic neck strain, yet its relationship with ONL and cervical sagittal imbalance remains underexplored in surgical CSM cohorts.
Methods: Cervical radiographs were analyzed. EOP hyperplasia was classified into three subtypes with standardized length measurements. Variables encompassed demographics, ONL-related indices, and sagittal parameters. Subtype comparisons and multivariate regression analyses (with EOP length as dependent variable) were conducted.
Results: Analysis of 187 CSM patients (64.2% male) identified gender-specific patterns: males exhibited greater EOP length (9.4±6.8 mm vs. 4.6±3.4 mm, p<0.001). Type III EOP demonstrated male predominance (82.4% vs. type I 31.8%, type II 51.4%; p<0.001), with associated longer hyperplasia length (11.6±6.6 mm vs. type II 5.1±1.9 mm, p<0.001). Type III EOP was associated with higher ONL prevalence (type III 64.8% vs. type I 45.5%, type II 41.9%; p=0.010) and longer ONL osteophyte length (type III 18.8±9.8 mm vs. type I 14.2±8.1 mm, type II 14.2±9.4 mm; p=0.046). Multivariate regression confirmed male sex (β=-3.82, p=0.009), ONL osteophyte length (β=0.16, p=0.017), T1 slope (β=0.27, p=0.041), and spino-cranial angle (β=-0.19, p=0.009) as factors independently associated with EOP length (adjusted R²=0.382).
Conclusions: Severe EOP hyperplasia exhibits a male-predominant distribution pattern and demonstrates significant radiological associations with ONL and cervical sagittal imbalance in CSM patients. These findings advocate for EOP evaluation in clinical evaluations to identify high-risk biomechanical profiles.
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