Analysis of demographics, risk factors, clinical presentation, and surgical treatment modalities for the ossified posterior longitudinal ligament

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Ossification of the posterior longitudinal ligament (OPLL) is a rare disease that results in progressive myeloradiculopathy related to pathological ossification of the ligament from unknown causes. Although it has long been considered a disease of Asian origin, this disorder is increasingly being recognized in European and North American populations. Herein the authors present demographic, radiographic, and comorbidity data from white patients with diagnosed OPLL as well as the outcomes of surgically treated patients.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between 1999 and 2010, OPLL was diagnosed in 36 white patients at Barrow Neurological Institute. Patients were divided into 2 groups: a group of 33 patients with cervical OPLL and a group of 3 patients with thoracic or lumbar OPLL. Fifteen of these patients who had received operative treatment were analyzed separately. Imaging analysis focused on signal changes in the spinal cord, mass occupying ratio, signs of dural penetration, spinal levels involved, and subtype of OPLL. Surgical techniques included anterior cervical decompression and fusion with corpectomy, posterior laminectomy with fusion, posterior open-door laminoplasty, and anterior corpectomy combined with posterior laminectomy and fusion. Comorbidities, cigarette smoking, and previous spine surgeries were considered. Neurological function was assessed using a modified Japanese Orthopaedic Association Scale (mJOAS).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A high-intensity signal on T2-weighted MR imaging and a history of cervical spine surgery correlated with worse mJOAS scores. Furthermore, mJOAS scores decreased as the occupying rate of the OPLL mass in the spinal canal increased. On radiographic analysis, the proportion of signs of dural penetration correlated with the OPLL subtype. A high mass occupying ratio of the OPLL was directly associated with the presence of dural penetration and high-intensity signal. In the surgical group, the rate of neurological improvement associated with an anterior approach was 58% compared with 31% for a posterior laminectomy. No complications were associated with any of the 4 types of surgical procedures. In 3 cases, symptoms had worsened at the last follow-up, with only a single case of disease progression. Laminoplasty was the only technique associated with a worse clinical outcome. There were no statistical differences (p &gt; 0.05) between the type of surgical procedure or radiographic presentation and postoperative outcome. There was also no difference between the choice of surgical procedure performed and the number of spinal levels involved with OPLL.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Ossification of the posterior longitudinal ligament can no longer be viewed as a disease of the Asian population exclusively. Since OPLL among white populations is being diagnosed more frequently, surgeons must be aware of the most appropriate surgical option. The outcomes of the various surgical treatments among the different populations with OPLL appear similar. Compared with other procedures, however, anterior decompression led to the best neurological outcomes.</jats:p></jats:sec>

Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis

“…A recovery rate > 75% is considered an excellent outcome, a recovery rate of 50%-75% is considered a good outcome, a recovery rate of 25%-49% is considered a fair outcome, and a recovery rate < 25% is considered a poor outcome. 21 …”

“…Surgical decompression and stabilization via cervical fusion is widely accepted as the optimal treatment for patients with cervical radiculopathy or myelopathy caused by OPLL. 21,34 Although anterior decompression and fusion (ADF) is associated with better maintenance of cervical lordosis, 38,48 it is also associated with higher rates of dysphagia and dural tears. 39 It is also a more technically difficult procedure than a decompression alone.…”

Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

“…We used an OPLL subtype classification by the Japanese Investigation Committee on the Ossification of the Spinal Ligaments that includes localized, segmental, continuous, and mixed types. 10 Cervical sagittal alignment was defined as the T-1 slope minus the C2-7 Cobb angle (T-1 slope minus cervical lordosis), which is the cervical analog to the pelvic incidence minus lumbar lordosis (PI -LL) mismatch. Postoperative radiological parameters were used in a linear regression analysis to demonstrate that a C2-7 SVA of 30 mm corresponded to a T-1 slope minus C2-7 Cobb angle threshold of 22° (Fig.…”

Cervical curvature, spinal cord MRIT2 signal, and occupying ratio impact surgical approach selection in patients with ossification of the posterior longitudinal ligament

“…Cervical OPLL occurs commonly in East Asian populations, most often affecting the spinal centrum (body) 5 (C5) or, less frequently, the C4 and C6 [1,2]. Partial lesions may begin from the trailing edge of the C2 odontoid process and extend to the posterior edge of the C7, sometimes reaching the upper thoracic centrum [2].…”

“…Ossification of the cervical posterior longitudinal ligament (OPLL) is characterized by progressive heterotopic coalescence of centers for chondrification and ossification that may mimic the symptoms of disc disease or spinal cord compression [1]. Cervical OPLL occurs commonly in East Asian populations, most often affecting the spinal centrum (body) 5 (C5) or, less frequently, the C4 and C6 [1,2].…”