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OPLL pp 85-93 | Cite as

Ossification of the Posterior Longitudinal Ligament in Evolution

  • Nancy Epstein

Abstract

Classical ossification of the posterior longitudinal ligament (OPLL) may be seen in 27% of Japanese and 25% of North American populations with myelopathy [1–3]. However, an additional subset of patients with a less mature form of OPLL has now been identified [4], Of 90 patients evaluated in our own OPLL series, 40 had classical OPLL, but 50 demonstrated an earlier variant of OPLL that appeared to be part of an evolving continuum toward classical OPLL [5]. This earlier form of OPLL was termed OPLL in evolution (OEV). These individuals, typically in their mid-forties rather than their late fifties, exhibit less significant spinal cord but more prominent nerve root compression. OEV appears on computed tomography-(CT-) based examinations to be composed of hypertrophied posterior longitudinal ligament (PLL), centered at the disk space but extending toward midvertebral body levels across single or multiple segments, with punctate, immature pearls of cartilage-calcification-ossification. Although CT and myelo-CT studies best distinguish OEV from classical OPLL, differentiation from disk disease and spondylosis, particularly using magnetic resonance imaging (MRI) alone, is more difficult.

Keywords

Disk Space Posterior Longitudinal Ligament Cervical Myelopathy Cervical Cord Compression Cervical Laminectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Nagashima C (1972) Cervical myelopathy due to ossification of the posterior longitudinal ligament. J Neurosurg 37: 653–659PubMedCrossRefGoogle Scholar
  2. 2.
    Onji Y, Akiyama H, Shimomura Y, Ono K, Hukuda S, Mizuno S (1967) Posterior paravertebral ossification causing cervical myelopathy; a report of 18 cases. J Bone Jt Surg 49A: 1314–1328Google Scholar
  3. 3.
    Tsuyama N (1984) Ossification of the posterior longitudinal ligament of the spine. Clin Orthop 184: 71–84PubMedGoogle Scholar
  4. 4.
    Epstein NE (1994) The surgical management of ossification of the posterior longitudinal ligament in 43 North Americans. Spine 19 (6): 664–672PubMedCrossRefGoogle Scholar
  5. 5.
    Epstein NE (1996) Advanced cervical spondylosis with ossification of the posterior longitudinal ligament and resultant neurological sequelae. J Spinal Disord (in press)Google Scholar
  6. 6.
    McAfee P, Regan JJ, Bohlman HH (1987) Cervical cord compression from ossification of the posterior longitudinal ligament in non-orientals. J Bone Jt Surg 69B (4): 569–575Google Scholar
  7. 7.
    Epstein NE (1992) Diagnosis and surgical management of ossification of the posterior longitudinal ligament. Contemp Neurosurg 22: 1–6Google Scholar
  8. 8.
    Epstein NE (1992) Ossification of the posterior longitudinal ligament: diagnosis and surgical management. Neurosurg Q 2: 223–241Google Scholar
  9. 9.
    Hase H, Hirasawa Y, Ogura S, Kusaka Y, Chatani K, Tanaka T, Kan T (1992) Severe cervical myelopathy due to diffuse hypertrophy of the cervical posterior longitudinal ligament. A case report. Spine 17 (11): 1417–1421PubMedCrossRefGoogle Scholar
  10. 10.
    Yamamoto I, Kageyama N, Nakamura K, Takahashi T (1979) Computed tomography in ossification of the posterior longitudinal ligament in the cervical spine. Surg Neurol 12: 414–418PubMedGoogle Scholar
  11. 11.
    Otake S, Matsuo M, Nishizawa S, Sano A, Kuroda Y (1992) Ossification of the posterior longitudinal ligament: MR evaluation. AJNR (Am J Neuroradiol) 13 (4): 1059–1067Google Scholar
  12. 12.
    Yamashita Y, Takashi M, Matsuno Y, Sakamoto YY, Yoshizumi K, Oguni T, Kojima R (1990) Spinal cord compression due to ossification of ligaments: MR imaging. Radiology 175: 843–848PubMedGoogle Scholar
  13. 13.
    Yamazaki A, Homma T, Ishikawa S, Okumura H (1991) Magnetic resonance imaging and histologic study of cervical posterior longitudinal ligament. A case report. Spine 16 (11): 1262–1266PubMedCrossRefGoogle Scholar
  14. 14.
    Yang DY, Wang YC, Lee CS, Chou DY (1992) Ossification of the posterior cervical longitudinal ligament. Acta Neurochir 115 (1–2): 15–19PubMedCrossRefGoogle Scholar
  15. 15.
    Hanakita J, Suwa H, Namura S (1994) The significance of the cervical soft disc herniation in the ossification of the posterior longitudinal ligament. Spine 19 (4): 412–418PubMedCrossRefGoogle Scholar
  16. 16.
    Hukuda S, Ogata M, Mochizuki T, Shichikawa K (1988) Laminectomy versus laminoplasty for cervical myelopathy: brief report. J Bone Jt Surg 70B (2): 325Google Scholar
  17. 17.
    Epstein NE, Danto J, Nardi D (1993) Evaluation of intraoperative somatosensory evoked potential monitoring in 100 cervical operations. Spine 18 (6): 737–747PubMedCrossRefGoogle Scholar
  18. 18.
    Boni M, Cherubino P, Denaro V, Bendzzo F (1984) Multiple subtotal somatectomy: technique and evaluation of a series of 39 cases. Spine 9 (4): 358–362PubMedCrossRefGoogle Scholar
  19. 19.
    Abe H, Tsuro M, Ito T (1989) Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg 55: 108–116Google Scholar
  20. 20.
    Epstein N (1993) The surgical management of ossification of the posterior longitudinal ligament in 51 patients. J Spinal Disord 6 (5): 432–454PubMedCrossRefGoogle Scholar
  21. 21.
    Herkowitz H (1988) A comparison of anterior cervical fusion, cervical laminectomy, and cervical laminoplasty for the surgical management of multiple level spondylotic radiculopathy. Spine 13 (7): 774–780PubMedCrossRefGoogle Scholar
  22. 22.
    Kamioka Y, Yamamoto H, Tani T, Ishida K, Sawamoto T (1989) Postoperative instability of cervical OPLL and cervical radiculomyelopathy. Spine 14 (11): 1177–1183PubMedCrossRefGoogle Scholar
  23. 23.
    Kawai S, Sunago K, Doi K, Saika M, Tagushi T (1988) Cervical laminoplasty (Hattori’s method) procedure and follow-up results. Spine 13 (11): 1245–1250PubMedCrossRefGoogle Scholar
  24. 24.
    Kimura I, Oh-Hama M, Shingu H (1984) Cervical myelopathy treated by canal-expansive laminoplasty. Computed tomographic and myélographie findings. J Bone Jt Surg 66A (6): 914–920Google Scholar
  25. 25.
    Matsuzaki H, Hoshino M, Kiuchi T, Toriyama S (1989) Dome-like expansive laminoplasty for the second cervical vertebra. Spine 14 (11): 1198–1203PubMedCrossRefGoogle Scholar
  26. 26.
    Mikawa Y, Shikata J, Yamamuro T (1987) Spinal deformity and instability after multilevel cervical laminectomy. Spine 12 (1): 6–11PubMedCrossRefGoogle Scholar
  27. 27.
    Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 6: 354–364PubMedCrossRefGoogle Scholar
  28. 28.
    Hukuda S, Ogata M, Mochizuki T, Shichikawa K (1988) Laminectomy versus laminoplasty for cervical myelopathy: brief report. J Bone Jt Surg 70B (2): 325Google Scholar
  29. 29.
    Miyazaki K, Kirita Y (1986) Extensive simultaneous multisegment laminectomy for myelopathy due to the ossification of the posterior longitudinal ligament in the cervical region. Spine ll(6): 531–542PubMedCrossRefGoogle Scholar
  30. 30.
    Nakano N, Nakano T, Nakano K (1988) Comparison of the results of laminectomy and open-door laminoplasty for cervical spondylotic myeloradiculopathy and ossification of the posterior longitudinal ligament. Spine 13 (7): 792–794PubMedCrossRefGoogle Scholar
  31. 31.
    Satomi K, Nishu Y, Kohna T, Kirabayashi K (1994) Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine 19 (5): 507–510PubMedCrossRefGoogle Scholar
  32. 32.
    Smith MD, Bolesta MJ, Leventhal M, Bohlman HH (1992) Postoperative cerebrospinal-fluid fistula associated with erosion of the dura. J Bone Jt Surg 74A (2): 270–277Google Scholar
  33. 33.
    Abe H, Tsuru M, Ito T, Koiwa M (1981) Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg 55: 108–116PubMedCrossRefGoogle Scholar
  34. 34.
    Epstein NE (1994) Ossification of the posterior longitudinal ligament in evolution in 12 patients. Spine 19(6):673–681PubMedCrossRefGoogle Scholar
  35. 35.
    Kojima T, Waga S, Kubo Y, Kanamaru K, Shimosaka S, Shimizu T (1989) Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament Neurosurgery (Baltimore) 24 (6): 864–872Google Scholar
  36. 36.
    Yu YL, Leong JCY, Fang D, Woo E, Huand CY, Lau HK (1988) Cervical myelopathy due to ossification of the posterior longitudinal ligament. Brain 11: 769–783CrossRefGoogle Scholar
  37. 37.
    Harsh GR IV, Sypert GW, Weinstein PR, Ross DA (1987) Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament. J Neurosurg 67 (3): 349–357PubMedCrossRefGoogle Scholar
  38. 38.
    Itoh, T, Tsuji H (1985) Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine. Spine 10: 729–736PubMedCrossRefGoogle Scholar
  39. 39.
    Kojima T, Waga S, Kubo Y, Kanamaru K, Shimosaka S, Shimizu T (1989) Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament. Neurosurgery (Baltimore) 24 (6): 864–872CrossRefGoogle Scholar
  40. 40.
    McAfee P, Regan JJ, Bohlman HH (1987) Cervical cord compression from ossification of the posterior longitudinal ligament in non-orientals. J Bone Jt Surg 69B (4): 569–575Google Scholar
  41. Sugar O (1981) Spinal cord malfunction after anterior cervical diskectomy. Surg Neurol 15 (l): 4–8Google Scholar
  42. 42.
    Yonenobu K, Hosono N, Iwasaki M, Asano MM, Ono K (1991) Neurologic complications of surgery for cervical compression myelopathy. Spine 16 (11): 1277–1282PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 1997

Authors and Affiliations

  • Nancy Epstein
    • 1
    • 2
  1. 1.Department of SurgeryNorth Shore University HospitalManhasset, Long IslandUSA
  2. 2.Cornell University Medical CollegeNew YorkUSA

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