Cervical OPLL

Ossification of Posterior Longitudinal Ligament

 FEATURES

 Ossification of ligament that runs behind the vertebral bodies in front of the spinal cord can compress the spinal cord.

 Up to 10% of Japanese and Chinese Men over the age of 60 have this condition

 Usually asymptomatic, unless patient has severe form or in the presence of congenital canal stenosis

Diagnosed when ossification originates outside the disc within the posterior longitudinal ligament which runs along the posterior aspect of the vertebral body.

It is associated with DISH and is classified as an enthesopathy , inflammation of tendon or ligament at the bone-ligament interface.

The mechanism of OPLL is similar to that which occurs in DISH with heterotopic bone formation in response to mechanical stress in other tissues. Cartilage cells proliferate first in the periosteum of the vertebral body and then in the annulus fibrosus, longitudinal ligament and dura. The ligament becomes calcified by a process of endochondral ossification. Mature lamellar bone is eventually formed.

 

Historical

It was first described in Guys Hospital Reports in 1838.

 

Epidemiology

Oriental Races especially Japanese have the highest incidence with a prevalence of about 2% in asymptomatic adults.

Previously thought rare, it is now found in approx 0.5% of Caucasians, increasing with age. In Japanese men >60 years of age, more than 10% have OPLL.

Males to female ratio 2:1

Associated with diabetes. 28% of patients with OPLL have diabetes and 18% are borderline diabetics. The incidence of OPLL in diabetic patients is around 16%.

Autoimmune markers HLA BW-40 and SA5 more common in Japanese with OPLL.

HLA-B27 which is associated with ankylosing spondylitis is not associated with OPLL.

 

Most patients with OPLL are asymptomatic.

Patients with developmental canal stenosis may be predisposed to earlier symptoms if OPLL is also present.

Symptoms are worsened by concurrent cervical spondylosis or infolding or ossified ligamentum flavum.

Mild neck sprains may cause syndromes ranging mild numbness to central cord syndrome and occasionally complete tetraplegia.

 

Treatment is according to symptom severity which may be defined by various scores, the most commonly used is probably the JOA (Japanese Orthopaedic Association) score.

 

Japanese Orthopedic Association (JOA) scoring system of severity of myelopathy.

<7 severe myelopathy

8-12 moderate myelopathy

>13 mild myelopathy

 

Surgery if performed may be either from an anterior approach which usually means a corpectomy and decompression with subsequent strut graft reconstruction. A posterior approach is the other option and this is either laminoplasty or a laminectomy with instrumentation.

Ossification of Posterior Longitudinal Ligament

Copyright 2008 Spine Care Hong Kong

SPINE CARE HONG KONG

ACCURATE DIAGNOSIS, STRUCTURED TREATMENT

CONTINUOUS

SEGMENTAL

MIXED

LOCALISED

TYPES OF OPLL

MRI

CT SCANS

CASE HISTORY

38 year old female

History of progressive upper and lower limb numbness

Associated with frequent falls, she was having severe difficulty walking

Admitted for suspected stroke

RADIOGRAPHS

C2 Vertebra

C3 Vertebra

C4 Vertebra

C6 Vertebra

C5 Vertebra

MANAGEMENT AND TREATMENT

Laminoplasty from C2 C7

Progress: Improvement in numbness and weakness of all 4 limbs, walking without the need for any walking aid.