Cervical Ossification of the Posterior Longitudinal Ligament: A Computed Tomography–Based Epidemiological Study of 2917 Patients

Abstract

Study Design:Retrospective cohort study.Objectives:To identify prevalence of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine in a large sample, to characterize spinal involvement, and to identify associations with patient characteristics.Methods:Computed tomography (CT) scans of all patients receiving cervical spine CT imaging in a level-1 emergency department from January 1, 2014 to December 31, 2014 were reviewed. Diagnosis and classification of OPLL was performed, and data for associated patients was obtained (age, sex, race, ethnicity, body mass index, diabetes). US Census data was referenced for the sample population. Statistical analysis included t test and chi-square testing, with significance cutoff P < .05.Results:There were no significant differences between the sample and population data. Of 2917 patients reviewed, 74 exhibited OPLL (2.5%). Age distribution between OPLL and non-OPLL cohorts was significantly different (P < .01), with highest prevalence of OPLL between ages 40 to 49 and 50 to 59 years. Comorbid diabetes also differed between groups (27% OPLL, 13% non-OPLL, P < .01). There was no difference in distribution of sex, race, or ethnicity. For OPLL, segmental type is most common (67.6%), involving on average 3.4 levels. OPLL involvement begins at any level, but ends most commonly at C6 (40.5%) or C7 (36.5%). Among OPLL patients, 18 (24.3%) demonstrated concurrent ponticulus posticus.Conclusions:This review of 2917 patients reaffirms previous data, with OPLL prevalence of 2.5%. In asymptomatic patients, incidental diagnosis is frequently seen as early as ages 40 to 49 years. OPLL is better characterized with a significant association with diabetes, segmental type being the most common, and the caudal extent typically involving C6-7 (77%).

Associations between Clinical Symptoms and Degree of Ossification in Patients with Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multi-Institutional Cross-Sectional Study

“…This heterotopic ossification occurs particularly in the cervical and thoracic spine, where the spinal cord lies inside the canal space, and can result in spinal disorders, even in asymptomatic cases following minor head trauma. Generally, in patients with OPLL, once the onset of myelopathic symptoms has started, neurologic dysfunction gradually deteriorates, and the patient will then require decompressive surgery [ 1 ]. Therefore, it is important that patients and physicians alike recognize the presence and location of OPLL and whether the entire spine is involved.…”

Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

“…The ectopic ossification causes chronic compression of the spinal cord, which leads to neurological dysfunction below the level of compression [ 3 ]. Although the prevalence of OPLL in the general population is relatively low, ranging from 0.1 to 2.5% in the United States and 1.9 to 4.3% in Japan [ 1 , 4 , 5 ], OPLL accounts for 18 to 35% as an etiology of degenerative cervical myelopathy (DCM), which requires surgical treatment [ 6 ]. Thus, OPLL is a major etiology of DCM, irrespective of race or region [ 6 , 7 ].…”

“…OPLL is associated with an increased prevalence of diabetes mellitus (DM) [ 5 , 8 , 9 ]. The prevalence of DM in patients with OPLL is 27% in the United States [ 5 ].…”

“…OPLL is associated with an increased prevalence of diabetes mellitus (DM) [ 5 , 8 , 9 ]. The prevalence of DM in patients with OPLL is 27% in the United States [ 5 ]. DM increases the prevalence of comorbidities, such as obesity, hypertension, common infections, and systemic vascular diseases [ 10 ], thereby exerting a negative impact on spinal surgeries [ 11 ].…”

Cervical Ossification of Ligamentum Flavum: Elaborating an Underappreciated but Occasional Contributor to Myeloradiculopathy in Aging Population Based on Synthesis of Individual Participant Data

“… 14–16 The prevalence of this phenomenon in the latest epidemiological study could be calculated as only 0.2%. 17 Different ossification lesions have common pathologic features, while simultaneously holding unique traits specific to each entity. Therefore, it is also essential to elucidate its epidemiological and clinical characteristics for targeted surgical strategies.…”