Ossification of the posterior longitudinal ligament of the spine

Alternate names

OPLL

Definition

Ossification of the posterior longitudinal ligament of the spine (OPLL) is a condition that is characterized by the calcification of the soft tissues that connect the bones of the spine, which may lead to compression of the spinal cord.

Epidemiology

• The incidence of OPLL is 2.4% in the Asian population, and 0.16% in the non-Asian population .
• OPLL is twice as common in men as it is in women, and symptomatic OPLL usually presents in the 5th to 6th decade of life.
• OPLL can be associated with other musculoskeletal diseases such as diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and other spondyloarthropathy .
• Schizophrenia patients have a 20% incidence rate for OPLL.

Cause

The exact underlying cause is currently unknown; however, scientists suspect that it is a multifactorial condition that is influenced by several different genetic and environmental factors.

Signs and symptoms

• Many affected people do not have any signs or symptoms, while others may experience mild pain or numbness in the arms and/or legs.
• As OPLL grows, symptoms increase in severity due to compression of the spinal cord and nerve roots.
• The most common symptoms in the early stages of OPLL include dysesthesia and tingling sensation in hands, and clumsiness. With the progression of neurologic deficits, lower extremity symptoms, such as gait disturbance may appear.
• OPLL patients show symptoms of myelopathy caused by spinal cord compression rather than radicular pain due to nerve roots compression.
• About 80-85% of OPLL patients experience a slow progression, but the symptoms become suddenly aggravated or even quadriplegia may appear by mild injuries.
• Rigidity of lower extremities is a common physical finding, an increase in deep tendon reflex, and extremity dysesthesia can be shown.

Diagnosis

An accurate diagnosis through the use plain radiograph, computed tomography, and magnetic resonance imaging findings is very important to monitor the development of symptoms and to make decisions regarding a treatment plan.

Treatment

• As symptomatic treatments, pain medication, topical agents, anti-inflammatory drugs, antidepressants, anticonvulsants, non-steroidal anti-inflammatory drugs and opioid can be applied, and bed rest and assist devices, such as a brace, are recommended for local stabilization. However, once the symptoms of myelopathy, such as gait disturbance and disorders of fine motor movement in the hand develop, appropriate recovery is not expected with conservative treatments.
• Surgical approach can be selected based on the degree of myelopathy, the number of involved segments, the location of the primary pathology, the sagittal balance of cervical spine and surgeon's experiences.<ref>Choi, B. W., Song, K. J., & Chang, H. (2011). Ossification of the posterior longitudinal ligament: a review of literature. Asian spine journal, 5(4), 267–276. https://doi.org/10.4184/asj.2011.5.4.267</ref>.

References

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NIH genetic and rare disease info

• NIH info on Ossification of the posterior longitudinal ligament of the spine

Ossification of the posterior longitudinal ligament of the spine is a rare disease.

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