Nature or nurture: a latent ossification of the posterior longitudinal ligament after atlantoaxial fusion. Illustrative case (original) (raw)
Related papers
Ossification of the posterior longitudinal ligament in the cervical spine
O ssificatiOn of the posterior longitudinal ligament is a condition of abnormal calcification of the posterior longitudinal ligament. The most common location is at the cervical spine region. The spinal cord can be compressed by this lesion, which can cause neurological deficits. The treatment of choice for patients with symptomatic OPLL is surgery to relieve spinal cord compression. However, there are many unresolved controversies concerning OPLL: the exact pathogenesis and natural history of OPLL are still unclear, there is no standard treatment for patients with asymptomatic OPLL, and there is disagreement about the best surgical approach for OPLL surgery. In this study, we review the current literature including the incidence, pathology, pathogenesis, natural history, clinical presentation, classification, radiological evaluation, and management of OPLL. Methods The PubMed databases were searched for publications from January 2000 through August 2010 using the MeSH terms "OPLL" and "ossification of posterior longitudinal ligament." The search was limited to articles in the English language. Related reference sections of recent articles were reviewed and pertinent articles identified. Full-texts manuscripts of all articles were obtained and reviewed. Radiographic images from the senior author's institution are also included. Results Incidence The incidence of OPLL was reported by Tsuyama et al. 126 The incidence is 2.4% in Asian populations and 0.16% in non-Asian populations, with the highest rates in Japan. OPLL is twice as common in men as in women, and symptomatic OPLL usually presents in the 5th to 6th decade of life. Most studies of OPLL are reported from Asian countries, but anecdotal reports of OPLL cases in European countries also exist in the literature. Maiuri et al. 72 reported on 8 Italian patients with cervical spine stenosis due to OPLL.
Spine Surgery and Related Research, 2021
Introduction: Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are widely performed to resolve anterior cervical spine compression. The main purpose of the different surgical techniques is to obtain an adequate decompression of the spinal cord and nerve roots, preserving spinal stability like in oblique corpectomy or leading to a final solid construct to achieve arthrodesis. Technical Note: We describe a surgical procedure for treating cervical spondylotic myelopathy(CSM) with ossification of the posterior longitudinal ligament (OPLL) at the level of C3-C4 and C4-C5. A double level discectomy C3-C4 and C4-C5 and selective posterior wedge corpectomy of C3, C4, and C5 were performed. Two cages (Zero-P VA) at C3-C4 and C4-C5 were positioned to obtain segmental stability and arthrodesis. An extended anterior cervical canal decompression was obtained and confirmed by postsurgical CT scan. At 15 months, dynamic X-ray showed fusion, and cervical magnetic resonance imaging (MRI) showed evidence of spinal canal decompression. Conclusions: Anterior cervical discectomy followed by selective wedge corpectomy appears to be a safe and effective technique for anterior spinal cord compression extending above and below the intervertebral disc space.
2021
This prospective multicenter study formed by the Japanese Ministry of Health, Labour and Welfare at 27 institutions aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL). Controversy exists regarding the role of instrumented fusion in the context of posterior surgical decompression for OPLL. Among the 479 patients enrolled, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, and increased signal intensity change on magnetic ...
Frontiers in Surgery, 2022
Objective: Cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) is not uncommon among Asian ethnic groups. Despite reports comparing the pros and cons of anterior-and posterior-only approaches, the optimal management remains debatable. This study aimed to evaluate the outcomes of patients who underwent a combined anterior and posterior approach, simultaneous circumferential decompression and fixation, for cervical OPLL. Method: The study retrospectively reviewed patients with OPLL and who underwent circumferential decompression and fixation, combined anterior corpectomy and posterior laminectomy. The clinical outcomes were evaluated by the Visual Analog Scale of neck and arm pain, the Japanese Orthopedic Association scores, Neck Disability Index, and Nurick scores at each time-point of evaluation. Radiological evaluations included plain and dynamic radiographs and computed tomography for every patient within 2 years post-operation. Subgroup analyses were further performed between the groups, with and without intra-operative cerebrospinal fluid (CSF) leakage. Results: A total of 41 patients completed the follow-up for more than 2 years (mean = 39.8 months) and were analyzed. Continuous-type OPLL was the most common (44%), followed by segmental (27%), mixed (22%), and localized types (7%) in the cohort. Myelopathy and all other functional outcomes improved significantly at 2 years post-operation (all p < 0.05). There were 13 (32%) patients who had intra-operative CSF leakage. At 2 years post-operation, there were no differences in the demographics, functional outcomes, and complication rates between the CSF-leakage and no-leakage groups. The CSF-leakage group had more patients with continuous-type OPLL than the no-leakage group (77 vs. 29%, p = 0.004 < 0.05). During the follow-up, there was no secondary or revision surgery for pseudomeningocele, pseudarthrosis, or other surgery-related complications. Kuo et al. Circumferential Surgery for OPLL Conclusions: Simultaneous circumferential decompression and fixation combine the surgical benefits of sufficient decompression by the posterior approach and direct decompression of OPLL by the anterior approach. It is an effective surgical option for patients with cervical myelopathy caused by OPLL, given that myelopathy unanimously improved without neurological complications in this study. The fusion rates were high, and reoperation rates were low. Despite higher rates of CSF leakage, there were no related long-term sequelae, and minimal wound complications.
Cervical Ossification of the Posterior Longitudinal Ligament: Anterior or Posterior surgery
2014
Ossification of the posterior longitudinal ligament (OPLL) is a complex multifactorial disease process combining both metabolic and biomechanical factors, most commonly found in men, the elderly and Asian patients. There are many diseases. There are many diseases associated with OPLL, such as diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and other spondyloarthropathies. Several factors have been reported to be associated with OPLL formation and progression, including genetic, hormonal, environmental, and lifestyle factors. However, the pathogenesis of OPLL is still unclear. Plain radiography, CT, and MR imaging are used to evaluate OPLL extension and the area of spinal cord compression. Management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be made case by case, depending on the patient's condition, level of pathology, type of OPLL, and the surgeon's experience. I...
Neurology India, 2005
Aims: To determine the surgical approach in patients with multisegmental (four or more segments) OPLL of the cervical spine. Methods and Materials: Data of 27 patients who had undergone either an anterior (corpectomy with excision of OPLL and interbody fusion=14 patients) or posterior approach (laminectomy=12, laminoplasty=1 patient) for the multisegmental cervical OPLL was analyzed retrospectively. The patients in each group were statistically similar in respect to preoperative factors such as age, duration of symptoms, preoperative modified Japanese orthopedic association score, OPLL thickness, effective canal diameter, and antero-posterior cord compression ratio. The clinical outcome was assessed by the Harsh grading system and recovery rate was assessed by Hirabayashi method. Results: There was no statistical difference in the outcome, and recovery rate. Nine patients developed complications after anterior approach in contrast to one after posterior approach. Conclusions: In patients with multisegmental cervical OPLL, there was no significant difference in the short-term recovery rate and outcome between two groups. The immediate postoperative complications were less in patients who had undergone posterior approach. From our analysis, it appears that the posterior approach is probably the preferred method of treatment in a multisegmental OPLL in absence of preoperative kyphosis.
Medicine, 2018
To investigate factors associated with surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL). This retrospective study included patients (662 males and 251 females; mean age 55.8 years) with symptomatic OPLL. All patients had been diagnosed with OPLL based on cervical magnetic resonance imaging and computed tomography scans. Demographic, surgical outcome was measured using visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scale scores. The results of our study indicated radicular pain was more common in segmental and circumscribe OPLL subtypes (P < 0.05). An anterior approach was favored in patients with less than 3 involved vertebral levels (P < 0.05). All surgical methods showed good outcomes (P < 0.05). Continuous and mixed OPLL subtypes showed worse surgical outcome with higher VAS and JOA scores (P < 0.05). Laminoplasty and anterior cervical discectomy and fusion were significantly associated with a higher recover...
Spine, 2012
Study Design. Prospective, comparative clinical study. Objective. To compare the clinical outcome of anterior decompression and fusion with fl oating method and laminoplasty in the treatment of cervical myelopathy caused by ossifi cation of the posterior longitudinal ligament (OPLL). Summary of Background Data. There have been no reports that have accurately and prospectively compared surgical outcomes after anterior decompression and posterior decompression. Methods. For cervical myelopathy caused by OPLL, we performed anterior decompression and fusion with fl oating method (ADF) in
Neurosurgical focus, 2011
Ossification of the posterior longitudinal ligament (OPLL) is an important cause of cervical myelopathy that results from bony ossification of the cervical or thoracic posterior longitudinal ligament (PLL). It has been estimated that nearly 25% of patients with cervical myelopathy will have features of OPLL. Patients commonly present in their mid-40s or 50s with clinical evidence of myelopathy. On MR and CT imaging, this can be seen as areas of ossification that commonly coalesce behind the cervical vertebral bodies, leading to direct ventral compression of the cord. While MR imaging will commonly demonstrate associated changes in the soft tissue, CT scanning will better define areas of ossification. This can also provide the clinician with evidence of possible dural ossification. The surgical management of OPLL remains a challenge to spine surgeons. Surgical alternatives include anterior, posterior, or circumferential decompression and/or stabilization. Anterior cervical stabilizat...
2021
Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. The bridging of ossified lesions to the vertebral body gradually increases, thereby decreasing the mobility of the cervical spine; thus, cervical spine function may decrease over time. However, cervical spine function in patients with cervical OPLL has not been evaluated in large prospective studies. Therefore, we conducted a prospective multicenter study to clarify whether ossification spread can influence cervical spine function and quality of life (QOL) in patients with cervical OPLL. In total, 238 patients (162 men, 76 women; mean age, 63.9 years) were enrolled from 16 institutions. Each patient underwent whole spine computed tomography and was evaluated cervical spine function and QOL using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). In the multivariate regression analysis, a higher neck VAS score and a larger number of bridge formations of OPLL ...