Ossification of the Posterior Longitudinal Ligament of the Cervical Spine

Matsunaga, Shunji; Sakou, Takashi

doi:10.1097/brs.0b013e318241ad33

Cited by 266 publications

(204 citation statements)

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“…Ossification of the posterior longitudinal ligament (OPLL) is a pathological condition causing ectopic bone formation in the spine ligament [3,7,14]. It is known that the presence of OPLL does not always indicate cervical myelopathy, and clinical symptoms may occur only when the ossified ligament develops to a certain degree [17].…”

Section: Introductionmentioning

confidence: 99%

Upregulated expression of PERK in spinal ligament fibroblasts from the patients with ossification of the posterior longitudinal ligament

et al. 2013

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Purpose Molecular mechanism of ossification of the posterior longitudinal ligament (OPLL) remains unclear. This study was to investigate different expressions of PERK between the spinal ligament fibroblasts from OPLL patients and non-OPLL patients, and demonstrate knockdown of PERK protein expression by RNA interference inhibiting expression of osteocalcin (OCN), alkaline phosphatase (ALP), and type I collagen (COL I) in the cells from OPLL patients. Methods Spinal ligament cells were cultured using tissue fragment cell culture and identified by immunocytochemistry and immunofluorescence. The mRNA expression of osteoblast-specific genes of OCN, ALP and COL I was detected in the cells from OPLL and non-OPLL patients by semiquantitative reverse transcription-polymerase chain reaction. The protein expression of PERK was detected by Western blotting. And then, after 72 h, when RNA interference against PERK was performed on the cells from OPLL patients, expression of the osteoblast-specific genes was compared again between the transfection group and non-transfection group. Results Spinal ligament fibroblasts were observed 7-10 days after cell culture. Immunocytochemistry and immunofluorescence exhibited positive results of vimentin staining. The mRNA expressions of OCN, ALP and COL I and protein expression of PERK in the cells from OPLL patients were significantly greater than those from non-OPLL patients. In addition, knockdown of PERK protein expression inhibited the mRNA expressions of OCN, ALP and COL I remarkably in the transfection group compared with the non-transfection group, at 72 h after RNA interference targeting PERK was performed on the cells from OPLL patients. Conclusions The cultured fibroblasts from OPLL patients exhibited osteogenic characteristics, and PERKmediated ER stress might be involved in development of OPLL.

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Section: Introductionmentioning

confidence: 99%

Upregulated expression of PERK in spinal ligament fibroblasts from the patients with ossification of the posterior longitudinal ligament

et al. 2013

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“…33 Recent research, however, has shown that OPLL has an incidence of 0.1%-1.7% among North Americans and Europeans with cervical spine disorders. 13,37 The increasing awareness of OPLL requires surgeons to be familiar with all viable treatment options.…”

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confidence: 99%

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

Mehdi

Alentado

Lee

et al. 2016

FOC

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OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL. METHODS A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I2 values. Forest plots were constructed for each analysis group. RESULTS Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior decompression alone in patients with OPLL. These results indicate that surgical decompression and fusion lead to a faster recovery, improved postoperative neurological functioning, and a lower incidence of OPLL progression compared with posterior decompression only. Furthermore, decompression and fusion did not lead to a greater incidence of complications compared with posterior decompression only.

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“…Matsunaga et al [2] found 71 % patients of OPLL without original myelopathy lived myelopathy-free during a 30-years follow-up, and advocated that preventive surgery was not necessary for non-myelopathic patients. We observed some cases of OPLL without symptoms of myelopathy (or not diagnosed myelopathy) who were rendered quadriplegic and/or presented with dyspnea after minor trauma like slipping from a chair in sitting position or cycling on macadam.…”

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confidence: 99%

Expert’s comment concerning Grand Rounds case entitled “Management of cervical myelopathy due to ossification of posterior longitudinal ligament in a patient with Alström syndrome” (by Bronek M. Boszczyk, Rishi Mugesh Kanna and Daniela Gradil)

Wen

2012

Eur Spine J

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The authors present an extremely rare case of Alström Syndrome who developed an extensive and serious ossification of spinal ligament [1]. Extensive ossification of both anterior and posterior longitudinal ligaments from C1 to T1 was observed with an occupying ratio more than 50 %, and combined with large osteophytes in front of vertebral bodies and ossification of ligament flavum from T1-3. Combined morbidity included sight and hearing loss, hepatic and renal dysfunction, hypertension, diabetes mellitus and polyarthritis. Progressive numbness in the finger tips was the chief complaint and further examination discovered weak hand grip and sensory loss below C5 dermatome, and positive myelopathic signs related to the spinal cord lesion. Posterior laminectomy from C3-6 without instrumentation was performed by the authors.Improved hand function and gait were observed after operation. Postoperative MRI demonstrated an excellent decompression of spinal cord.Severe OPLL is hard to deal with. The communication problem in this case provided extra difficulty to the operation, so did multiple combined morbidities. The authors should be praised for their great efforts in this case. I admired the final decision of a simple yet effective way with laminectomy alone. I would do the same for the patient.Matsunaga et al.[2] found 71 % patients of OPLL without original myelopathy lived myelopathy-free during a 30-years follow-up, and advocated that preventive surgery was not necessary for non-myelopathic patients. We observed some cases of OPLL without symptoms of myelopathy (or not diagnosed myelopathy) who were rendered quadriplegic and/or presented with dyspnea after minor trauma like slipping from a chair in sitting position or cycling on macadam. To prevent the catastrophic outcome, we have now accumulated more cases and look for risk factors that may indicate precautionary surgical treatment in non-myelopathic patients.For the surgical strategy of OPLL, controversies continue. Anterior corpectomy has the advantage of thorough decompression with removal of the ossified mass, which promises a better long-term result [3]. The major shortcoming of anterior approach (AA) is that it is not appropriate for very extensive lesion and that the fusion rate drops in that condition. An anterior approach is always considered as technically demanding. Posterior approach (PA) is preferred by some surgeons for safety and ease, but it could not provide adequate decompression of spinal cord in patients with preoperative kyphosis, and the results were not as good as AA, especially in massive ossification and in long follow-up. Mean improvement rate after operation

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Ossification of the Posterior Longitudinal Ligament of the Cervical Spine

Abstract: OPLL should be managed on the basis of the consideration of its natural history. Elucidation of pathogenetic genes of OPLL will introduce a new approach for management of OPLL.

Cited by 266 publications

References 19 publications

Upregulated expression of PERK in spinal ligament fibroblasts from the patients with ossification of the posterior longitudinal ligament

Upregulated expression of PERK in spinal ligament fibroblasts from the patients with ossification of the posterior longitudinal ligament

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

Expert’s comment concerning Grand Rounds case entitled “Management of cervical myelopathy due to ossification of posterior longitudinal ligament in a patient with Alström syndrome” (by Bronek M. Boszczyk, Rishi Mugesh Kanna and Daniela Gradil)

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