OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT

POSTERIOR LONGITUDINAL LIGAMENT

Situated within the vertebral canal and extends along the posterior surfaces of the bodies of vertebrae

Spans from the body of the Axis (C2) to the posterior surface of the sacrum

Functions to prevent hyperflexion of the vertebral column

Ossification = bone tissue formation from a cartilage

OPLL is a calcification of the soft tissues that connect the spinal bones which results in a narrowing of the spinal canal and compression of the cervical spinal cord.

Most common levels are C4-C6

Common cause of cervical myelopathy

Most patients with OPLL are asymptomatic with no symptoms at all, but others may experience mild pain and numbness in the arms and/or legs to complete numbness in the extremities. Most symptomatic patients with OPLL present with neurological deficits such as myelopathy, radiculopathy, and/or bowel and bladder symptoms.

OPLL is often associated with several other entitiesdiffuse idiopathic skeletal hyperostosis (DISH)ossification of the ligamentum flavum(ossification of the yellow ligament (OYL))ankylosing spondylitis

Stages of spinal cord damage by OPLLstage 0: normal or mild compression of anterior horn without neuronal lossstage 1: mild compression of anteriorhorn with partial neuronal loss.stage 2: marked deformity of anterior horn; severe neuronal loss.stage 3: severe spinal cord damage

Management can range from being conservative to surgical removal.

Surgical options can include anterior, posterior or combined approach.

An anterior approaches (plated multilevel anterior discectomy and fusion, anterior cervical corpectomy with fusion (ACF)), may provide more direct decompression and best improve myelopathy. The soft-tissue morbidity associated with the anterior approach may be greater.

Posterior approaches (e.g. laminectomy and fusion and laminoplasty) may be better tolerated in older patients.