Increased Prevalence of Ossification of Posterior Longitudinal Ligament and Increased Bone Mineral Density in Patients with Ossification of Nuchal Ligament

Abstract

ObjectiveThere are also few studies demonstrating the relationship between ossification of nuchal ligament (ONL) and ossification of posterior longitudinal ligament (OPLL). We compared the prevalence, location, and type of OPLL between patients with ONL and matched patients without ONL.We also compared the bone mineral densities (BMDs) between the 2 groups.Methodstotal of 124 cervical ONL patients were enrolled in this study. The control group of 124 patients was matched with 124 patients with ONL by age and sex on a 1:1 basis to minimize confounding factors. We reviewed the prevalence, location, and type of OPLL in both groups.ResultsThe prevalence of OPLL was almost 2.5 times greater in patients with ONL than those without ONL. The mean value of BMD in patients with ONL was greater at the lumbar spine (L1-L4) than in patients without ONL. The mean T score of the lumbar spine was 0.25±1.68 in the patients with ONL and -0.73±1.64 in the patients without ONL.ConclusionThe prevalence of OPLL in patients with ONL was significantly higher than in patients without ONL. Because ONL is innocuous and may be seen more readily than OPLL on simple cervical radiographs, clinicians should consider the possibility of coexisting OPLL when ONL, especially extensive ONL, is detected in patients with neck pain, radiculopathy, or myelopathy, to facilitate proper treatment.

Potential Link between Ossification of Nuchal Ligament and the Risk of Cervical Ossification of Posterior Longitudinal Ligament: Evidence and Clinical Implication from a Meta‐Analysis of 8429 Participants

“…A total of 16 studies were subsequently assessed by full‐text review, and 6 studies were excluded for the following reasons: no full text ( n = 2), duplicate data ( n = 1), and not reporting the association between ONL and OPLL ( n = 3). Finally, the remaining 10 studies 23, 25–27, 31–36 met our selection criteria and were included in the review. The detailed search strategy through the PRISMA flow diagram is presented in Fig.…”

“…Cervical OPLL was diagnosed with cervical CT. As for the extent of COPLL, the common assessment criteria were applied in 2 studies: there was a short‐level (1–3 levels) OPLL group and a long‐level (4–6 levels) OPLL group based on the number of intervertebral spaces involved by OPLL 23, 26 . Long‐level OPLL was considered more severe than short‐level OPLL.…”

“…found that patients with ONL were more likely to have COPLL than those without ONL (7.2% vs 1.6%, odds ratio [OR] = 4.8, P < 0.001). Kim et al 26 . demonstrated that the prevalence of COPLL was almost 2.5 times greater in patients with ONL than those without ONL, and the morphology of ONL was related to the degree of COPLL involved.…”

Ossification of Posterior Longitudinal Ligament of Cervical Spine Among Omani Patients Referred for CT Scan at a Tertiary Care Hospital in Oman

“…7,8 Most recent studies have used CT or MRI for diagnosis. 9-12 However, OPLL of cervical spine diagnosis using lateral X-rays can lead to underestimation of the condition, whereas MRI is prone to overestimation. This is because of the difficulty in distinguishing between hypertrophy and ossification.…”

Factors associated with bone metabolism in patients with cervical ossification of the posterior longitudinal ligament accompanied with diffuse idiopathic skeletal hyperostosis

“…Other studies that investigated multiple types of ossification of the ligaments, including OPLL, ossification of ligamentum flavum, ossification of anterior longitudinal ligament, DISH, and ossification of nuchal ligament, reported that there were more patients with multiple combined types of ossification than there were those with only one type [ 1 ]. Additionally, both patients with one type and those with multiple types of ossification had significantly greater bone mineral density (BMD) than did those with no ossification [ 7 – 9 ].…”