Symptomatic ossification of the posterior longitudinal ligament of the cervical spine: pictorial essay

Ossification of the posterior longitudinal ligament: a review

Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, the elderly, and Asian patients. 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. Most symptomatic patients with OPLL present with neurological deficits such as myelopathy, radiculopathy, and/or bowel and bladder symptoms. There are some reports of asymptomatic OPLL. Both static and dynamic factors are related to the development of myelopathy. 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. In this paper, the authors attempt to review the incidence, pathology, pathogenesis, natural history, clinical presentation, classification, radiological evaluation, and management of OPLL.

Ossified Posterior Longitudinal Ligament with an Atypical Clinical Presentation in an Indian Male

Ossification of the posterior longitudinal ligament is an uncommon disorder mostly seen in the Japanese population and hence termed by some the “Japanese disease”. Ossification of the posterior longitudinal ligament is more common in the cervical spine2. Clinically it is usually asymptomatic, but serious neurological deficits have been seen in some patients2. The ossified mass composed of lamellar bone and focal calcified cartilage expands in volume causing spinal canal stenosis and cord compression. Morphologically, four forms of ossification of the posterior longitudinal ligament have been described: continuous, segmental, mixed and rarely a focal retrodiscal form4. CT scan is the method of choice for detecting the presence and extent of the ossified mass. MR imaging is helpful in depicting the nature of cord compression such as myelomalacia, edema, demyelination or cyst formation and root sleeve involvement.

Ossification of the posterior longitudinal ligament

A 51-year-old gentleman of Chinese descent presented for neurological evaluation following a two-year history of cervical neck pain associated with left arm numbness. His symptoms were initially stable, but had progressed over the past six months to include weakness of his entire left arm and leg and symptoms of bladder urgency. Two weeks prior to presentation, he suffered repeated falls due to worsening gait difficulties. The past medical history was significant for type II diabetes mellitus.