Ossification of the Posterior Longitudinal Ligament: Pathophysiology, Diagnosis, and Management

Abstract

Ossification of the posterior longitudinal ligament (OPLL) occurs as heterotopic bone forms in the posterior longitudinal ligament, resulting in neural compression, myelopathy, and radiculopathy. OPLL is most commonly observed in East Asian populations, with prevalence rates of 1.9% to 4.3% reported in Japan. OPLL rates are lower in North American and European patients, with reported prevalence of 0.1% to 1.7%. Patients typically develop symptoms due to OPLL in their cervical spines. The etiology of OPLL is multifactorial, including genetic, metabolic, and anatomic factors. Asymptomatic or symptomatic patients with OPLL can be managed nonsurgically, whereas patients with neurologic symptoms may require surgical decompression from an anterior, posterior, or combined approach. Surgical treatment can provide notable improvement in neurologic function. Surgical decision making accounts for multiple factors, including patient comorbidities, neurologic status, disease morphology, radiographic findings, and procedure complication profiles. In this study, we review OPLL epidemiology and pathophysiology, clinical features, radiographic evaluation, management, and complications. O ssification of the posterior longitudinal ligament (OPLL) occurs as the heterotopic bone replaces the posterior longitudinal ligament (PLL), resulting in varying degrees of spinal stenosis and neurologic dysfunction. OPLL occurs in a 2:1 male-to-female ratio, with variable geographic prevalence. The condition was first described in Japanese and Eastern Asian patients, with reported prevalence in Japan ranging from 1.9% to 4.3% and approaching 3.0% in other Asian countries. 1 Rates are lower in North America and Europe, where prevalence is reported from 0.1% to 1.7%. 2 True prevalence rates may be higher because CT studies in Japan have found cervical OPLL in 6.3% of asymptomatic, healthy subjects, 3 and up to 71% of patients noted to have OPLL were found to remain asymptomatic over a 30year follow-up. 1 When symptoms develop, OPLL patients may experience radiculopathy and myelopathy and sustain spinal cord injury (SCI), typically around the age of 40 to 60 years. Given the risk of neurologic injury associated with OPLL, it

Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor

“…In order to further reduce patient complications, we studied the effect of laminoplasty preservation of the PLC in spinal surgery to improve spinal deformity. The PLC runs along the dorsal plexus of the vertebral body down the sacrum which increases cervical stability by providing posterior support to the vertebral body and limiting flexion and lateral bending and rotation 19,20 . What's more, there are also many complications associated with PLC resection, including symptoms such as cerebrospinal fluid leakage and spinal cord compression 21,22 .…”

“…Preservation of the PLC significantly improves the sagittal balance of the postoperative cervical spine. The damage of PLC resulting from surgery can lead to changes in spinal stability 20,23,24 . This segmental ROM can lead to an increased risk of pain and postoperative deformity 25,26 .…”

“…The PLC runs along the dorsal plexus of the vertebral body down the sacrum which increases cervical stability by providing posterior support to the vertebral body and limiting flexion and lateral bending and rotation. 19 , 20 What's more, there are also many complications associated with PLC resection, including symptoms such as cerebrospinal fluid leakage and spinal cord compression. 21 , 22 Therefore, PLC is important in maintaining spinal stability and preventing complications, so the decision to perform surgical resection needs to be considered holistically.…”

“…The damage of PLC resulting from surgery can lead to changes in spinal stability. 20 , 23 , 24 This segmental ROM can lead to an increased risk of pain and postoperative deformity. 25 , 26 In addition, preservation of the PLC improved the patient's axial symptoms significantly.…”

The role of miRNA and lncRNA in heterotopic ossification pathogenesis

“…It is the most common in the cervical spine. OPLL affects approximately 0.1–4.3% of the world population, with a high prevalence in Asian populations [ 22 ]. Unlike other types of acquired HO, it does not result from trauma.…”