Ossification of the posterior longitudinal ligament explained

Ossification of the posterior longitudinal ligament
Field:Rheumatology

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]

Causes

Genetic and environmental factors appear to play a role in pathogenesis. Dr James Hong, lecturer at the University of Toronto with a special focus in cervical spinal myelopathy, states that sitting still for too long contributes to OPLL. 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.

Treatment

Surgical management options include extensive cervical laminectomy with or without an additional posterior arthrodesis, anterior decompression and arthrodesis, and posterior cervical laminoplasty. 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. Symptoms typically last approximately 13 months. 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.[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]

Notes and References

  1. Book: Greenberg, Mark. Handbook of neurosurgery. registration. 2006-01-01. Thieme. 978-1588904577. 474019573.
  2. Belanger. Theodore. 2005. Ossification of the Posterior Longitudinal Ligament. Journal of Bone and Joint Surgery. 87. 3. 610–615. 10.2106/JBJS.C.01711. 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. 1067-151X. 11476536. 10.5435/00124635-200107000-00006. 265656 .
  4. Meyer. Paul. 1999. diffuse idiopathic skeletal hyperostosis in the cervical spine. Clinical Orthopaedics & Related Research. 359. 359. 49–57. 10.1097/00003086-199902000-00006. 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. 0362-2436. 6420895. 10.1097/00007632-198310000-00003. 21825972 .
  6. NURJCK. S.. 1972-01-01. Brain. en. 95. 1. 87–100. 10.1093/brain/95.1.87. 5023093. 0006-8950. The Pathogenesis of the Spinal Cord Disorder Associated with Cervical Spondylosis.
  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. 10.3171/spi.2004.100.3.0245. 15029912. 1547-5654.
  8. Choi. Byung-Wan. Song. Kyung-Jin. Chang. Han. Ossification of the Posterior Longitudinal Ligament: A Review of Literature. Asian Spine Journal. 5. 4. 267–76. 10.4184/asj.2011.5.4.267. 3230657. 22164324. 2011.
  9. Tsuyama. N.. 1984-04-01. Ossification of the posterior longitudinal ligament of the spine. Clinical Orthopaedics and Related Research. 184. 71–84. 0009-921X. 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. 10.3171/2010.12.FOCUS10277. 1092-0684. 21434820. 20216810 . free.
  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. 10.3109/s10165-008-0036-1. 18306978 . 33766083 . 1439-7595.

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