Computed tomography of calcification and ossification of posterior longitudinal ligament of the spine

Prevalence and characteristics of thoracic ossification of the posterior longitudinal ligament in 3299 Black patients: a cross-sectional study of a prospectively registered database

OBJECTIVES

To the best of our knowledge, the prevalence of thoracic ossification of the posterior longitudinal ligament (T-OPLL) in the Black population has never been studied and is still unknown. The purpose of this study was to examine the prevalence and characteristics of T-OPLL in the Black patients.

METHODS

This is a cross-sectional study. All patients who underwent chest CT for the trauma screening and whose race was classified as 'Black' on the questionnaire were recruited in the study from March 2019 to March 2020. Demographic data, including age, sex, body mass index (BMI) and presence of diabetes mellitus (DM), were recorded. T-OPLL was defined as ectopic OPLL of more than 2 mm thickness in the axial plane image of the CT scan. The prevalence and characteristics of T-OPLL, and the association of T-OPLL with BMI and DM were evaluated.

RESULTS

A total of 3299 Black patients (1507 women and 1792 men) were included for the analysis. The prevalence of T-OPLL was 1.5% (50 patients), with 2.4% for females and 0.8% for males. The highest prevalence was observed in patients at the age of 70 years (3.8%). Thickness of T-OPLL was between 2 and 3 mm in 46% (23/50) of the patients, and the largest thickness was 6.1 mm. T-OPLL was significantly associated with female sex and the presence of DM.

CONCLUSIONS

The prevalence of T-OPLL was 1.5% in the 3299 Black patients who underwent chest CT for the trauma screening, with 2.4% for females and 0.8% for males.

Diagnosis, Management, and Clinical Outcomes of Tandem Thoracic and Lumbar Stenosis: A Systematic Literature Review and Case Series

BACKGROUND

A scarcity of data has been reported on tandem thoracic lumbar stenosis, which might be related to either the rarity or underdiagnosis of the condition. We have presented a systematic review of the clinical presentation, diagnosis, and treatment patterns for patients with symptomatic tandem thoracic and lumbar stenosis.

METHODS

A PubMed/MEDLINE search was performed to find reports of patients with symptomatic tandem thoracic and lumbar stenosis.

RESULTS

The review identified 10 studies with a total of 48 patients with tandem thoracic and lumbar stenosis. Most patients (n = 41; 85%) had had tandem stenosis diagnosed at the initial investigation, with 71% of the reports citing ossification of the ligamentum flavum as a contributing etiology. A few patients (n = 7; 15%) had had thoracic lesions diagnosed after neurologic deterioration that had occurred after lumbar surgery for previously suspected isolated lumbar stenosis. Surgical management varied from isolated thoracic decompression, staged decompression, and simultaneous decompression. Most patients (n = 41; 87%) showed improved neurologic status after surgery.

CONCLUSION

Ossification of the ligamentum flavum might play a key role in the pathogenesis of the condition. Most patients with tandem thoracic and lumbar stenosis will show improvement after surgical decompression. Although the limited evidence available has raised concerns regarding neurologic deterioration after initial lumbar decompression in patients with coexisting thoracic stenosis, the data are insufficient to definitively determine an optimal surgical strategy. Further research is needed to identify the optimal diagnostic and management criteria for patients with symptomatic tandem thoracic and lumbar stenosis.

Epidemiology of ossification of the spinal ligaments and associated factors in the Chinese population: a cross-sectional study of 2000 consecutive individuals

Background

The epidemiology and cause of ossification of the spinal ligaments (OSL) remains obscure. To date, there is no study that comprehensively evaluates the prevalence, distribution, and concomitance of each type of OSL by CT among general Chinese population. We therefore aimed to comprehensively investigate epidemiological characteristics of OSL using whole spine CT in the Chinese population and examine the factors that correlate with the presence of OSL.

Methods

Ossification of the posterior longitudinal ligament (OPLL), ligamentum flavum (OLF), anterior longitudinal ligament (OALL), nuchal ligament (ONL), and diffuse idiopathic skeletal hyperostosis (DISH) were evaluated from the subjects who underwent PET/CT for the purpose of cancer screening in our hospital. Prevalence, distribution, and concomitance of OSL were reviewed. Logistic regression analysis was performed to identify the risk factors of OSL.

Results

A total of 2000 subjects (1335 men and 665 women) were included. The prevalence rate of cervical OPLL (C-OPLL) was 4.1%, thoracic OPLL (T-OPLL) 2.25%, lumbar OPLL (L-OPLL) 0.8%, thoracic OLF (T-OLF) 37.65%, lumbar OLF (L-OLF) 1.45%, ONL 31.5%, DISH 3.85%. The most commonly involved level was C5 for C-OPLL, T1 for T-OPLL, T10 for T-OLF, and T8/9 for OALL. 21% of subjects with C-OPLL had T-OPLL, 44% of C-OPLL had T-OLF, 38% of T-OPLL had C-OPLL, 53% of T-OPLL had T-OLF, 44% of L-OPLL had T-OPLL, and 56% of L-OPLL had T-OLF. The average age of OSL-positive subjects was significantly higher than that of OSL-negative subjects. The results of the multiple regression analysis revealed that males had a strong association with DISH (odds ratio, 3.15; 95% confidence interval, 1.27–7.78; P = 0.013).

Conclusion

The prevalence of OSL in the Chinese was revealed. Tandem ossification is not uncommon in people with OSL. There is a high incidence of multiple-regional OPLL in the whole spine. Approximately half of the subjects with OPLL coexist with T-OLF. For patients with clinical symptoms induced by OPLL, thorough evaluation of whole spine using CT is recommended.

Ossification of the posterior longitudinal ligament of the cervical spine in 3161 patients: a CT-based study

STUDY DESIGN

A cross-sectional study.

OBJECTIVE

To examine the prevalence of ossification of the posterior longitudinal ligament (OPLL) and ossification of the nuchal ligament (ONL) of the cervical spine in the San Francisco area.

SUMMARY OF BACKGROUND DATA

The prevalence of OPLL and ONL is unknown in the non-Asian population.

METHODS

This computed tomography-based cross-sectional study assessed the prevalence of OPLL and ONL within the cervical spine of patients treated at a level 1 trauma center between 2009 and 2012. The prevalence of both OPLL and ONL was compared between racial groups.

RESULTS

Of the 3161 patients (mean age, 51.2 ± 21.6 yr; 66.1% male), there were 1593 Caucasians (50.4%), 624 Asians (19.7%), 472 Hispanics (14.9%), 326 African Americans (10.3%), 62 Native Americans (2.0%), and 84 Others (2.7%). The prevalence of cervical OPLL was 2.2% (95% confidence interval [CI]: 1.7-2.8). The adjusted prevalence was 1.3% in Caucasian Americans (95% CI: 0.7-2.3), 4.8% in Asian Americans (95% CI: 2.8-8.1), 1.9% in Hispanic Americans (95% CI: 0.9-4.0), 2.1% in African Americans (95% CI: 0.9-4.8), and 3.2% in Native Americans (95% CI: 0.8-12.3). The prevalence of OPLL in Asian Americans was significantly higher than that in Caucasian Americans (P = 0.005). ONL was detected in 346 patients and the prevalence was 10.9% (95% CI: 10.0-12.0). The adjusted prevalence of ONL was 7.3% in Caucasian Americans (95% CI: 5.8-9.3), 26.4% in Asian Americans (95% CI: 21.9-31.5), 7.4% in Hispanic Americans (95% CI: 5.2-10.5), 2.5% in African Americans (95% CI: 1.2-4.9), and 25.8% in Native Americans (95% CI: 16.5-37.5). ONL was significantly more common in Asian Americans than in Caucasian Americans, Hispanic Americans, and African Americans (P = 0.001).

CONCLUSION

This study also demonstrated that OPLL and ONL were significantly more common in Asian Americans than in Caucasian Americans.

LEVEL OF EVIDENCE

3.

Diagnosis of Cervical OPLL in Lateral Radiograph and MRI: Is it Reliable?

OBJECTIVE

Cervical OPLL is a relatively common cause of developing cervical myelopathy or radiculopathy in Asians. Cervical OPLL is sometimes missed in lateral radiography or MRI. In the present study, we analyzed the diagnostic accuracy of cervical OPLL in lateral radiography and MRI compared to CT scan.

METHODS

This is a retrospective study of forty-six patients who underwent decompressive surgery anteriorly or posteriorly in our institute. All patients were diagnosed with cervical OPLL by CT scan. The patients were grouped into continuous type, segmental type, mixed type, and localized type. We then evaluated lateral radiographs and MRI compared to CT scans. The diagnostic accuracy and false negative rates in lateral radiograph and MRI were evaluated.

RESULTS

In a total of 46 patients diagnosed with cervical OPLL in CT scans, diagnostic accuracy using lateral radiograph and MRI were 52.2%(24/46) and 58.7%(27/46), respectively. In the continuous type group, diagnostic accuracy using lateral radiograph and MRI were 85.7%(6/7) and 100.0%(7/7). In the segmental type group, diagnostic accuracy using lateral radiograph and MRI were 27.3%(6/22) and 31.8%(7/22). In the mixed type group, diagnostic accuracy was 91.7%(11/12) in lateral radiograph and 83.3%(10/12) in MRI. In the localized group, diagnostic accuracy was 20.0%(1/5) in lateral radiograph and 60.0%(3/5) in MRI.

CONCLUSION

The diagnostic accuracy of cervical OPLL using lateral radiograph and MRI was less than using CT scan. For the best treatment plan, preoperative CT scan should be performed to detect conditions of ossifications such as cervical OPLL.

Surgical treatment of destructive calcific lesions of the cervical spine in scleroderma: case series and review of the literature

STUDY DESIGN

An independent retrospective chart review combined with a review of current literature.

OBJECTIVES

To describe a series of destructive, calcific masses of the cervical spine causing pain, neurologic dysfunction, and instability in patients with scleroderma and detail the surgical interventions required. To review benign, calcific cervical spine lesions associated with scleroderma and collagen vascular disorders.

SUMMARY OF BACKGROUND DATA

Little is know about the diagnosis and management of the destructive, calcific lesions of scleroderma in the cervical spine.

METHODS

The medical and radiographic records of 3 patients with scleroderma lesions in the cervical spine were reviewed. A computer-based literature search of Ovid and PubMed databases was used to compile a comprehensive review of the topic.

RESULTS

The perioperative and surgical management of 3 cases of scleroderma of the cervical spine are discussed in the context of a complete literature review on the topic. These complex lesions were found to require significant resources with regard to diagnosis and management.

CONCLUSIONS

Destructive, calcific masses in the cervical spine associated with scleroderma and an indication for surgical treatment are rare. Treatment is complex and not without significant risk to the patient.

Aberrant internal carotid artery in the middle ear

This study was undertaken to evaluate the incidence, typical clinical signs, and proper management of patients with an aberrant internal carotid artery in the middle ear as presented in a case report and review of the relevant literature. A total of 86 cases were reviewed concerning gender, affected side, presenting symptoms, findings on clinical and radiologic examination, and further treatment. About two thirds of the patients (68.6%) were female. The right side was affected in 40 patients, and both sides were affected in 13 patients. Hearing loss (41 patients) and pulsatile tinnitus (26 patients) were the most common symptoms. Preponderances of affected side and gender seem to be reduced by the increasing number of reports. Bilateral findings are not unusual, indicating meticulous examination of both sides. Glomus tumors often mimic an aberrant internal carotid artery. If vascular malformations in the middle ear are suspected, high-resolution computed tomography or magnetic resonance angiography is required before any surgical intervention to exclude vascular malformations. Brisk bleeding, hemiparesis, aphasia, deafness, Horner's syndrome, and intractable vertigo may result if the lesion is injured unintentionally. Once the disorder is correctly diagnosed, yearly follow-up is advisable.

Aberrant internal carotid artery lying within the middle ear. High resolution CT diagnosis and differential diagnosis

The CT signs of aberrant course of the internal carotid artery are presented and are contrasted against those of anomalously high jugular bulb, glomus tympanicum and cholesterol granuloma.