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Wang MY, Thambuswamy M. Ossification of the posterior longitudinal ligament in non-Asians: demographic, clinical, and radiographic findings in 43 patients. Neurosurg Focus 2011; 30:E4. [PMID: 21434820 DOI: 10.3171/2010.12.focus10277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Ossification of the posterior longitudinal ligament (OPLL) is a disorder afflicting as many as 2% of East Asians. However, reports of OPLL in non-Asians have been sporadic in the medical literature. This study describes clinical and radiographic findings with OPLL in non-Asians at a tertiary care center treating a diverse multiethnic population.
Methods
Over a 6-year period, 43 patients not of East Asian descent presented to an urban tertiary medical center with OPLL. Patient data, including ethnicity, spinal cord function, Nurick grade, radiographic findings, OPLL subtype, and degree of cervical stenosis, were recorded.
Results
The average patient age was 59 years (range 32–92 years) with 18 women and 25 men. There were 22 Caucasian patients, 17 Hispanic patients, and 4 Black patients. With respect to the radiographic findings, OPLL morphology was continuous in 19, segmental in 17, mixed in 6, and other in 1. Average canal diameter was 7.6 mm (range 4.2–9.0 mm) at the most stenotic points. The mean Nurick grade was 2.95 at presentation, but 7 of the patients had OPLL identified incidentally and with early or minimal symptoms and signs of myelopathy.
Conclusions
Ossification of the posterior longitudinal ligament in non-Asians demonstrates similar demographic and radiographic characteristics as in East Asians. The representation of different ethnic groups mirrors the demographics of the medical center population in general, showing no specific predilection for particular ethnic groups. Surgical decompression in appropriately selected patients results in similar rates of improvement when compared with the Japanese literature.
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Sakou T, Matsunaga S, Koga H. Recent progress in the study of pathogenesis of ossification of the posterior longitudinal ligament. J Orthop Sci 2000; 5:310-5. [PMID: 10982675 DOI: 10.1007/s007760050169] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The pathogenesis of ossification of the posterior longitudinal ligament (OPLL) is still unknown. Gene analysis and molecular biology have been introduced in recent years, and etiologic and pathological clarifications are being achieved. An important role of the genetic background in the development of this disease was demonstrated by pedigree survey, twin survey, and HLA haplotype study. The results of gene linkage study showed that patients with OPLL have a significantly higher incidence of genetic abnormalities found in the XI collagen (alpha)2 gene (COL11A2) region. From the gene mapping of this abnormality, the abnormal N-propeptide of the COL11A2 gene was found to be responsible. We are planning to undertake genetic analysis of the whole of chromosome VI to find the pathogenic genes responsible for OPLL in addition to COL11A2. A cell biological approach is also necessary to make clear the relationship between abnormalities of the COL11A2 gene and ossification of the ligament. In future, identification of the susceptible gene, elucidation of its function, and study toward the development of preventive and therapeutic drugs will advance.
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Affiliation(s)
- T Sakou
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890, Japan
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Jayakumar PN, Kolluri VR, Vasudev MK, Srikanth SG. Ossification of the posterior longitudinal ligament of the cervical spine in Asian Indians--a multiracial comparison. Clin Neurol Neurosurg 1996; 98:142-8. [PMID: 8836587 DOI: 10.1016/0303-8467(96)00004-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ossification of the Posterior longitudinal ligament (OPLL) has been thought to be a predominantly Japanese disease with few reports among the non-orientals and Caucasians. A prospective clinicoradiological study of 47 symptomatic Caucasoid Indians is reported. Twenty-seven patients presented with myelopathy, twelve with myeloradiculopathy and six with radiculopathy. 'Total' configuration of OPLL was the most frequent (70%). The most frequent location was at C3 and C4 levels. The thickness of OPLL ranged from 2.5 mm to 11.5 mm. Canal stenosis was most severe in patients with 'total' type of OPLL. Ossification of other spinal ligaments were seen in 50% of the patients. Twenty-one patients underwent decompressive laminectomy and twenty of them improved. The difference in the cervical canal diameters and the configuration of OPLL between the Japanese and our population (Caucasoid Indians) may be of therapeutic relevance.
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Affiliation(s)
- P N Jayakumar
- Department of Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Del Conte L, Tassinari T, Trucco M, Serrato O, Badino R. Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. Clinical, neuroradiological and neurophysiological study on 9 cases. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1992; 13:767-80. [PMID: 1483860 DOI: 10.1007/bf02229163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine is considered to be uncommon in western countries, although widely known and studied in Japan. We report on 9 cases of OPLL cervical myelopathy investigated by x-ray films and cervical CT and by somatosensory evoked potentials. The patients reported spastic tetraparesis, sensory disorders of the limbs and, in one case, sphincter incontinence. Neuroradiological examinations showed that the posterior columns of the spinal cord were more affected than the roots. Our data suggest that OPLL is more frequent in the West than has so far been reported and that combined radiological and neurophysiological investigation ensures correct diagnosis and accurate assessment of the cord impairment.
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Affiliation(s)
- L Del Conte
- Divisione di Neurologia, Ospedali Riuniti di Pietra e Finale Ligure
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Nakamura H, Crock HV, Galbally BP, Dawson J. Ossification of the posterior longitudinal ligament in the thoracic spine causing intermittent paraplegia in an Englishman: case report. PARAPLEGIA 1992; 30:277-81. [PMID: 1625898 DOI: 10.1038/sc.1992.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Compression of the spinal cord due to ossification of the posterior longitudinal ligament (OPLL) often leads to quadriplegia or paraplegia in Japanese patients. This disease is uncommon in other races. We report the case of a middle-aged Englishman who presented with complaints of intermittent paraparesis due to OPLL at the T5-T6 level in his thoracic spine.
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Yang DY, Wang YC, Lee CS, Chou DY. Ossification of the posterior cervical longitudinal ligament. Acta Neurochir (Wien) 1992; 115:15-9. [PMID: 1595391 DOI: 10.1007/bf01400585] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Forty patients with cervical myelopathy due to OPLL (Ossification of the Posterior Longitudinal Ligament) of the cervical spine were studied. According to Abe's or Yamamoto's classification, 12 of them had a 50% decrease in the cross-sectional area of the spinal canal. Subtotal vertebrectomy was carried out in 8 of these patients and the remaining 4 patients received posterior decompression. We concluded that anterior decompression, if possible, is the treatment of choice and posterior decompression is recommended only for the longitudinal type involving more than 3 segments.
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Affiliation(s)
- D Y Yang
- Department of Surgery, Taichung Veteran General Hospital, Taiwan, Republic of China
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Lee T, Chacha PB, Khoo J. Ossification of posterior longitudinal ligament of the cervical spine in non-Japanese Asians. SURGICAL NEUROLOGY 1991; 35:40-4. [PMID: 1898499 DOI: 10.1016/0090-3019(91)90200-s] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
"The Japanese disease," ossification of the posterior longitudinal ligament, is not confined to the Japanese only. A similar incidence of 0.8% was found in this study among non-Japanese Asians. Of 5167 patients who attended the Mount Elizabeth Hospital in Singapore for cervical spine complaints, 43 patients were found to have ossification of the posterior longitudinal ligament, forming the largest non-Japanese series. All but one patient were of Mongolian origin, and males were affected four times more commonly than females. Diabetes mellitus was present in 16%. There was a significant association between ossification of the posterior longitudinal ligament and calcification of other cervical paraspinal ligaments. It is suggested that a generalized tendency to calcification may be an important etiological factor in ossification of the posterior longitudinal ligament. Four of the patients required surgery, and in our experience, anterior spinal fusion with removal of the ossified ligament or multilevel laminoplasty gives satisfactory results.
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Affiliation(s)
- T Lee
- Department of Surgery, National University Hospital, Singapore
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Nose T, Egashira T, Enomoto T, Maki Y. Ossification of the posterior longitudinal ligament: a clinico-radiological study of 74 cases. J Neurol Neurosurg Psychiatry 1987; 50:321-6. [PMID: 3104541 PMCID: PMC1031797 DOI: 10.1136/jnnp.50.3.321] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A clinico-radiological analysis of 74 cases of ossification of the posterior longitudinal ligament is reported. Eighteen cases (24%) were asymptomatic or only had neck or shoulder pain; 16 cases (22%) showed signs of radiculopathy, and the remaining 40 cases (54%) had myelopathy. Ossification of the posterior longitudinal ligament developed most frequently at C5, and was rare in thoracic and lumbar regions. Ossification of the posterior longitudinal ligament led to stenosis of the spinal canal; more marked stenosis caused clinical myelopathy. The data showed that 30% of stenosis caused by ossification of the posterior longitudinal ligament was critical for the production of myelopathy.
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Lecky BR, Britton JA. Cervical myelopathy due to ossification of the posterior longitudinal ligament. J Neurol Neurosurg Psychiatry 1984; 47:1355-6. [PMID: 6439826 PMCID: PMC1028149 DOI: 10.1136/jnnp.47.12.1355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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10
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D'Ettore M, Venturi C, Paradiso C, Moschini F, Reale F, Federico A. Cervical myelopathy secondary to ossification of the posterior longitudinal ligament (a case report). ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1984; 5:203-7. [PMID: 6432727 DOI: 10.1007/bf02043224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case of ossification of the posterior longitudinal ligament, documented by spinal X-ray, myelography and CT scanning of the spinal cord is reported. The patient underwent decompressive laminectomy by posterior approach, which was successful. The case is discussed in the light of recent published data.
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Yagan R, Khan MA, Bellon EM. Spondylitis and posterior longitudinal ligament ossification in the cervical spine. ARTHRITIS AND RHEUMATISM 1983; 26:226-30. [PMID: 6401996 DOI: 10.1002/art.1780260219] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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12
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Ross ITH. A simplified method of monitoring muco-ciliary transport. Br J Radiol 1980. [DOI: 10.1259/0007-1285-53-632-821-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Shaw DG. Ossification of the spine. Br J Radiol 1980; 53:821. [PMID: 6777013 DOI: 10.1259/0007-1285-53-632-821-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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17
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Park WM, Mourad K. Ossification and calcification of the posterior longitudinal ligament of the spine. Br J Radiol 1980; 53:375-6. [PMID: 6991052 DOI: 10.1259/0007-1285-53-628-375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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