Ossification Posterior Longitudinal Ligament


http://upload.orthobullets.com/topic/2046/images/ct sagittal_moved.jpg
http://upload.orthobullets.com/topic/2046/images/xray lateral.jpg
  • A common cause of cervical myelopathy in the Asian population
  • Epidemiology
    • demographics
      • Asian
        • most common in but not limited to
      • men > women
    • location
      • most common levels are C4-C6
      • 95% of ossification is located in C spine
  • Pathophysiology
    • cause is unclear but likely multifactorial
    • associated factors
      • diabetes
      • obesity
      • high salt-low meat diet
      • poor calcium absorption
      • mechanical stress on posterior longitudinal ligament
  • Symptoms
    • often asymptomatic
    • symptoms and exam findings consistent with symptoms of myelopathy topic
  • Physical exam
    • findings of myelopathy
  • Radiographs
    • lateral radiograph often shows ossification of PLL 
    • important to evaluate sagittal alignment of cervical spine
  • MRI
    • study of choice to evaluate spinal cord compression
  • CT
    • study of choice to delineate bony anatomy of ossified posterior longitudinal ligament
  • Nonoperative
    • observation
      • indicated only in patient with mild symptoms who are not candidates for surgery
  • Operative
    • direct or indirect surgical decompression followed by stabilization
      • indications
        • indicated in most patients with significant symptoms
Surgical Techniques
  • Interbody fusion without decompression
    • indications
      • in patients with dynamic myelopathy
    • technique
      • theory behind technique is that by removing motion at stenotic levels trauma to the cord is eliminated
  • Anterior corpectomy with or without OPLL resection
    • indications
      • indicated in patient with kyphotic cervical spine where posterior decompression is not an option
    • technique
      • one method to avoid a dural tear is to perform a corpectomy, and instead of removing the OPLL from the dura, allow it to "float" in the corpectomy site
  • Posterior laminoplasty or laminectomy with fusion
    • indications
      • only effective in lordotic spine as it allows the spinal cord to drift away from  the anterior compression of the OPLL
      • considered a safer and preferable approach due to the difficulty of resecting the OPLL off the dura from an anterior approach
    • techniques
      • fusion should be performed with laminectomy to avoid post-laminectomy kyphosis
    • complications
      • there is a risk of postoperative OPLL growth
  • Recurrence of OPLL
    • recurrance reduced with
      • complete resection
      • leaving OPLL to float in corpectomy site

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