Ossification of the posterior longitudinal ligament

Ossification of the posterior longitudinal ligament (OPLL) is a process of fibrosis, calcification, and ossification of the posterior longitudinal ligament of the spine, that may involve the spinal dura.[1] Once considered a disorder unique to people of Asian heritage, it is now recognized as an uncommon disorder in a variety of patients with myelopathy.[2]

Ossification of the posterior longitudinal ligament
Posterior longitudinal ligament (running vertically in the center) in the thoracic region.
SpecialtyRheumatology

Causes

The causes of OPLL are unknown. However, genetic and environmental factors appear to play a role in pathogenesis.[2][1] OPLL may also be associated with diffuse idiopathic skeletal hyperostosis[3][4]

Diagnosis

Myeolography, including post-myelographic CT is likely the most effective imaging study an accurate diagnosis.[1]

Treatment

Surgical management options include extensive cervical laminectomy with or without an additional posterior arthrodesis, anterior decompression and arthrodesis, and posterior cervical laminoplasty.[3] Treatment decisions can be made based on a grading systems devised by Hirabayashi et al.,[5] supplemented by the Nurick myelopathy classification system.[6]

Prognosis

Most patients suffer from only mild symptoms.[1] Symptoms typically last approximately 13 months.[1] Of patients without myelopathy at initial presentation, only 29% of them will develop myelopathy within 30 years.[7]

Epidemiology

The age range of patients with OPLL is from 32 to 81 years (mean = 53), with a male predominance.[1][8] Prevalence is higher in those of Japanese or Asian ancestry (2-3.5%) [9] and rarer in other racial groups (0.16%).[10] Schizophrenia patients in Japan may have as high as 20% incidence.[11]

References
  1. Greenberg, Mark (2006-01-01). Handbook of neurosurgery. Thieme. ISBN 978-1588904577. OCLC 474019573.
  2. Belanger, Theodore (2005). "Ossification of the Posterior Longitudinal Ligament". Journal of Bone and Joint Surgery. 87 (3): 610–615. doi:10.2106/JBJS.C.01711. PMID 15741630.
  3. Belanger, T. A.; Rowe, D. E. (2001-07-01). "Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations". The Journal of the American Academy of Orthopaedic Surgeons. 9 (4): 258–267. doi:10.5435/00124635-200107000-00006. ISSN 1067-151X. PMID 11476536.
  4. Meyer, Paul (1999). "diffuse idiopathic skeletal hyperostosis in the cervical spine". Clinical Orthopaedics & Related Research. 359 (359): 49–57. doi:10.1097/00003086-199902000-00006. PMID 10078128.
  5. Hirabayashi, K.; Watanabe, K.; Wakano, K.; Suzuki, N.; Satomi, K.; Ishii, Y. (1983-10-01). "Expansive open-door laminoplasty for cervical spinal stenotic myelopathy". Spine. 8 (7): 693–699. doi:10.1097/00007632-198310000-00003. ISSN 0362-2436. PMID 6420895.
  6. NURJCK, S. (1972-01-01). "The Pathogenesis of the Spinal Cord Disorder Associated with Cervical Spondylosis". Brain. 95 (1): 87–100. doi:10.1093/brain/95.1.87. ISSN 0006-8950. PMID 5023093.
  7. Matsunaga, Shunji; Sakou, Takashi; Taketomi, Eiji; Komiya, Setsuro (2004-03-01). "Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study". Journal of Neurosurgery: Spine. 100 (3): 245–248. doi:10.3171/spi.2004.100.3.0245. ISSN 1547-5654. PMID 15029912.
  8. Choi, Byung-Wan; Song, Kyung-Jin; Chang, Han (2011). "Ossification of the Posterior Longitudinal Ligament: A Review of Literature". Asian Spine Journal. 5 (4): 267–76. doi:10.4184/asj.2011.5.4.267. PMC 3230657. PMID 22164324.
  9. Tsuyama, N. (1984-04-01). "Ossification of the posterior longitudinal ligament of the spine". Clinical Orthopaedics and Related Research (184): 71–84. ISSN 0009-921X. PMID 6423334.
  10. Wang, Michael Y.; Thambuswamy, Michael (2011-03-01). "Ossification of the posterior longitudinal ligament in non-Asians: demographic, clinical, and radiographic findings in 43 patients". Neurosurgical Focus. 30 (3): E4. doi:10.3171/2010.12.FOCUS10277. ISSN 1092-0684. PMID 21434820.
  11. Matsunaga, Shunji; Koga, Hiroaki; Kawabata, Naoya; Kawamura, Ichiro; Otusji, Masaki; Imakiire, Takanori; Komiya, Setsuro (2008-06-01). "Ossification of the posterior longitudinal ligament in dizygotic twins with schizophrenia: a case report". Modern Rheumatology. 18 (3): 277–280. doi:10.3109/s10165-008-0036-1. ISSN 1439-7595.
Classification
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