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Year : 2000  |  Volume : 10  |  Issue : 4  |  Page : 253-254
Ossification of posterior longitudinal ligament (OPLL) presenting as cervical myelopathy


1 Dept of Radiodiagnosis, JNMCH, AMU, Aligarh, India
2 Dept of Medicine, JNMCH, AMU, Aligarh, India

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Keywords: OPLL, ossification posterior longitudinal ligament, cervical spine, myelopathy

How to cite this article:
Khalid M, Mannan KA, Hussain S, Reyazuddin. Ossification of posterior longitudinal ligament (OPLL) presenting as cervical myelopathy. Indian J Radiol Imaging 2000;10:253-4

How to cite this URL:
Khalid M, Mannan KA, Hussain S, Reyazuddin. Ossification of posterior longitudinal ligament (OPLL) presenting as cervical myelopathy. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Sep 18];10:253-4. Available from: http://www.ijri.org/text.asp?2000/10/4/253/30574
Since 1960, OPLL has been well recognized as "Japanese Disease" and its etiology is still not known. The disease most commonly affects the cervical spine, but the thoracic and lumbar regions are not exempt [1]. OPLL has been reported to attack 1-3% of symptomatic Japanese patients and such patients usually have been found to have a narrow spinal canal as the basic abnormality. CT is a highly reliable modality for evaluating the extent of the lesions and the configuration of the spinal canal [2],[3]. Since ossification of longitudinal ligament occurs at several levels, meticulous attention to both clinical and radiological findings is mandatory in determining the level of involvement [3],[5].


   Case Report Top


A fifty-years-old man presented with complaints of gradually progressive heaviness of both upper and lower extremities with pain in the neck over the past several years. The pain had worsened further in the recent past. He had a completely uneventful life before the development of symptoms. His physical examination revealed diffuse weakness of all extremities involving the proximal and distal musculature, with exaggerated deep tendon reflexes. Plantar responses were extensor. No cranial, sensory nerve, bladder or bowel involvement was noted.

Routine laboratory investigations were within normal limits. Latex fixation test and VDRL was also found to be negative. Initially cervical spine radiographs [Figure - 1] were obtained. These showed osteophytosis as well as a dense opacity along the posterior aspect of the vertebral body mainly at the C3, C4 levels. CT myelography [Figure - 2] revealed a hyperdense intraspinal pedunculated mass along the posterior aspect of vertebral body with obvious cord compression. The hyperdense intraspinal mass was larger in size at C4 than at C3. Involvement was found to be segmental along the posterior aspect of vertebral body. Thus a diagnosis of OPLL, causing extradural cord compression and myelopathic symptoms, was arrived at.


   Discussion: Top


Ossification of posterior longitudinal ligament (OPLL) is a well-documented cause of cervical spine stenosis and myelopathy among Japanese patients. Its etiology still remains obscure [1],[2]. This entity is rarely seen in Indians. OPLL occurs after the age of 40 years and the most commonly affected region is the cervical spine, usually at C4/5, although the thoracic and lumbar regions are not exempt [2],[3]. The frequency of involvement diminishes as the level descends as follows: cervical 70-75%, thoracic 15-20% and lumbar 10%. The unexplained intimate relationship of OPLL with cervical spondylosis and diffuse idiopathic skeletal hyperostosis (DISH) is well known [4].

Only a minority of patients who have OPLL are symptomatic. Symptoms in OPLL may vary from none at all to cervical radiculomyelopathy with spastic palsy of extremities, which usually correlates with the thickness of the ligament ossification. The important determinant in the development of neurological symptoms is residual canal size [1],[3]. Enlargement and extent of OPLL determines the type of neurological symptoms. Myelopathic symptoms are reported more in OPLL near the midline of the spinal canal while the radiculopathic symptoms occur more often in those who showed eccentric OPLL [2],[3],[4].

MRI is the gold standard as far as spinal imaging is concerned and shows the manifestations of the disease well.

OPLL is also well defined by CT. In addition CT myelographic images permit an analysis of the degree of encroachment on the spinal canal and compression of the cord that is superior to that obtained from conventional tomography or myelography [1],[3],[4].

This article of ours shows characteristic images of OPLL on plain radiographs and CT.

 
   References Top

1.Harsh IV, Griffith R, Sypert GW, Wienstein PR, Ross DA, Wilson Charles B. Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament. J Neurosurgery 1987; 67: 349-357   Back to cited text no. 1    
2.Hyman RA, Merten CW, Liebeskind AL, Naidich JB and Stein HL. Computed Tomography in ossification of the posterior longitudinal spinal ligament. Neuroradiology 1977; 13: 227-228.   Back to cited text no. 2    
3.Tadao N, Taikei E, Takao E, Yutaka M. Ossification of posterior longitudinal ligament, a clinico radiological study of 47 cases. Journal of Neurology, Neurosurgery and Psychiatry 1987; 50: 321-326.   Back to cited text no. 3    
4.Hiramatsn Y, Nobechi T. Calcification of posterior longitudinal ligament of spine among Japanese. Radiology 1971; 100: 307-312.   Back to cited text no. 4    
5.Nagashima C. Cervical myelopathy due to ossification of posterior longitudinal ligament. J Neurosurgery 1972; 37: 653-660.  Back to cited text no. 5  [PUBMED]  

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Correspondence Address:
M Khalid
Dept of Radiodiagnosis, JNMCH, AMU, Aligarh 202 002
India
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Source of Support: None, Conflict of Interest: None


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