Ossification_of_the_posterior_longitudinal_ligament
Ossification of the posterior longitudinal ligament
Medical condition
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 | |
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Posterior longitudinal ligament (running vertically in the center) in the thoracic region. | |
Specialty | Rheumatology |
Genetic and environmental factors appear to play a role in pathogenesis.[2][1] 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]
Myeolography, including post-myelographic CT is likely the most effective imaging study an accurate diagnosis.[1]
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]
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]
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]
- Greenberg, Mark (2006-01-01). Handbook of neurosurgery. Thieme. ISBN 978-1588904577. OCLC 474019573.
- 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.
- 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.
- 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.
- 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.
- 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. S2CID 20216810.
- 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. PMID 18306978. S2CID 33766083.