Ossification of the posterior longitudinal ligament: a review of literature

Abstract

Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, in the elderly, and in Asian patients. The disease can start with mild or no symptoms, but some patients progress slowly to develop symptoms of myelopathy. 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. When symptoms are mild and non-progressive, conservative treatments and periodic observations are good enough, but once symptoms of myelopathy are present and neurologic symptoms are progressive, the treatment of choice is surgery to relieve spinal cord compression. Surgical management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be decided carefully with various considerations. The patient's neurological condition, location and extent of pathology, cervical kyphosis, presence or absence of accompanied instability, and the individual surgeon's experience must be an important factors that should be considered before surgery.

Keywords: Cervical spine; Ossification; Posterior longitudinal ligament.

Fig. 1

(A) The sagittal computerized tomography scan of 66-year-old male patient showed mixed type ossification of the posterior longitudinal ligament (OPLL). (B) Follow up copmuted tomography scan of two years after laminoplasty. OPLL mass grew the most 2 years after surgery. (C) Five years after surgery, there showed mild increasement of the OPLL mass than post-operative 2 years finding, but the difference was minimal compared with first 2 years.

Fig. 2

(A) Preoperative computed tomography and magnetic resonance imaging. (B) After C6 corpectomy and fusion using autogenous strut iliac graft, there showed complete decompression and recovery of subarachnoid space.

Fig. 3

(A) Preoperative computed tomography and magnetic resonance imaging (MRI). (B) Follow up MRI after posterior en block laminectomy of C3 and C4. (C) Preoperative MRI and follow up MRI. This 56-year-old male patient was performed open door laminoplasty.