Risk factors for progression of ossification of the posterior longitudinal ligament in asymptomatic subjects

Doi, Tôru; Sakamoto, Ryuji; Horii, Chiaki; Okamoto, Naoki; Nakajima, Koji; Hirai, Shima; Oguchi, Fumihiko; Kato, So; Taniguchi, Yuki; Matsubayashi, Yoshitaka; Hayashi, Naoto; Tanaka, Sakae; Oshima, Yasushi

doi:10.3171/2020.3.spine2082

Cited by 15 publications

(18 citation statements)

References 26 publications

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“…12 Several clinical risk factors are considered associated with OLF, such as age, sex, ethnicity, obesity, ankylosing spondylitis, history of hypertension and diabetes, diffuse skeletal hyperostosis, uric acid, and abnormal metabolism of trace elements. 8 , 13 , 14 Furthermore, metabolic syndrome and leptin resistance are regarded as risk factors closely related to the process of TOLF. 15 Therefore, identifying the risk factors for TOLF is essential for the management of the disease.…”

Section: Introductionmentioning

confidence: 99%

Clinical Risk Factors for Thoracic Ossification of the Ligamentum Flavum: A Cross-Sectional Study Based on Spinal Thoracic Three-Dimensional Computerized Tomography

Zhang¹,

Deng²,

Zhang³

et al. 2022

RMHP

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Background Inconsistent results of the clinical risk factors associated with thoracic ossification of the ligamentum flavum (TOLF) have been reported in limited previous studies. Purpose This retrospective study aimed to investigate the potential risk factors for TOLF by a retrospective cross-sectional study, which may provide valuable experience for further clinical and pathophysiological research. Methods A total of 2247 asymptomatic participants, who underwent spinal thoracic three-dimensional computerized tomography (3D-CT) scans at our institution from January 2016 to December 2019, were enrolled in this study according to the screening criteria. Demographic information such as age, sex, height, weight, body mass index (BMI), smoking and drinking history, diastolic blood pressure (DBP), systolic blood pressure (SBP), and pulse pressure (PP) were recorded. Laboratory results included serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG), uric acid (UA), creatinine (Cr), calcium, and phosphorus. Participants were divided into TOLF group and non-TOLF group in accordance with the thoracic 3D-CT manifestation. Results TOLF was observed in 153 (6.81%) asymptomatic participants. Comparison of demographic data and laboratory examinations between the two groups showed that participants in the TOLF group were older, had a higher BMI, as well as higher levels of DBP. In addition, there was no significant difference in sex, drinking, tobacco use, SBP, TC, TG, PP, and levels of LDL-C, HDL-C, sUA, sCr, calcium, and phosphorus between the two groups. Furthermore, dichotomous logistic regression analyses revealed that age (OR = 1.018, p = 0.041) and BMI (OR = 1.090, p < 0.001) were risk factors for TOLF. Conclusion Our study reveals that age and BMI are clinical risk factors for the development of TOLF, while age cannot be identified as an independent risk factor for female in subgroup analysis.

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Section: Introductionmentioning

confidence: 99%

Clinical Risk Factors for Thoracic Ossification of the Ligamentum Flavum: A Cross-Sectional Study Based on Spinal Thoracic Three-Dimensional Computerized Tomography

Zhang¹,

Deng²,

Zhang³

et al. 2022

RMHP

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“…The fact that OPLL is presumed to develop in patients during their 50s and 60s, or at a younger age, may also support this idea. [23][24][25] An acceptable interpretation for the decreased prevalence of fatty liver in elderly patients with OPLL is that fatty liver progresses to liver brosis with age and is no longer diagnosed as fatty liver. It has been reported that fat deposits in hepatocytes tend to disappear as liver brosis progresses in patients aged of ≥ 70.…”

Section: Discussionmentioning

confidence: 99%

“…This grouping was performed because fat deposits in the hepatocytes tend to disappear as liver brosis progresses from the eighth decade of life onward (> 70 years), [20][21][22] and OPLL is presumed to develop in the sixth (50-60 years old) and seventh (60-70 years old) decade of life, or earlier. [23][24][25] We also divided patients according to OPLL type: patients with OPLL only in the cervical spine were classi ed into the localized-OPLL group, and those with OPLL in the thoracolumbar spine, with or without cervical spine involvement, were classi ed into the diffuse-OPLL group. This classi cation was based on our previous study showing that patients with myelopathy caused by thoracic OPLL have distinct features, such as severe obesity, early symptom onset, and diffuse ossi cation of the spinal ligaments.…”

Section: Grouping Of Patients With Opll According To Their Age and Opll Typementioning

confidence: 99%

Close Association Between Non-Alcoholic Fatty Liver Disease and Ossification of the Posterior Longitudinal Ligament of the Spine

Endo

Koike

Miyoshi

et al. 2021

Preprint

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Ossification of the posterior longitudinal ligament (OPLL) of the spine is a disease of unknown etiology occurring frequently in individuals with metabolic disturbances. Obesity has been suggested as a potential risk factor for the severity of OPLL. We aimed to investigate whether non-alcoholic fatty liver disease (NAFLD) is associated with OPLL severity. We assessed the severity of NAFLD by a liver-to-spleen (L/S) ratio on computed tomography (CT) scans of 85 symptomatic OPLL patients at a single institution in Japan. We also assessed the severity of OPLL by CT reconstruction sagittal and axial images. The prevalence of NAFLD in middle-aged patients (age < 70 years, n = 50) was 80.3%, which was 2.5-8 times higher than that in the general Japanese population (9–30%). The ossification index of the spinal ligaments increased in proportion to the severity of fatty liver. The L/S ratio was revealed as a significant risk factor associated with the total ossification index (standardized β: -0.40, 95% confidence interval: -54.34 to -4.22). This study suggests the potential contribution of NAFLD to the progression of OPLL. The close association between NAFLD and OPLL demonstrated in this study warrants further study to elucidate the causal nature of this relationship.

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“…To date, the etiology and pathomechanism of OPLL remain unclear. Multiple studies have suggested that OPLL is a multifactorial disease influenced by numerous genetic and non‐genetic factors 15 , 16 . Non‐genetic factors include mechanical stress, degeneration process, diet, and biological rhythm.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Follow‐Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study

Liu

Zhai

Song

et al. 2021

Orthopaedic Surgery

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Objective: To examine the postoperative progression of multilevel thoracic posterior longitudinal ligament (OPLL) at circumferential decompression (CD) levels and evaluate the long-term results after CD via the posterior approach.Methods: Clinical data from 16 patients with thoracic myelopathy secondary to OPLL who underwent CD at a single center were evaluated retrospectively from 2007 to 2014 and were followed up for more than 60 months. Patients of all sexes and ages were included in the study. Thin-slice computed tomography scans obtained at the time of surgery and the most recent follow-up were analyzed. The ossified area was measured on the axial reconstructed scan of the most obvious protrusion of ossification at the CD level. The neurological outcomes were evaluated using modified Japanese Orthopaedic Association (JOA) scores and Hirabayashi recovery rates (HRRs). Continuous variables were presented as the mean AE standard deviation and were analyzed using the Student's t-test, while categorical variables were tested using Fisher's exact test.Results: Among all patients, the most predominant type was the mixed type (9/16, 56.3%), while the circumscribed type was only found in two patients (12.5%), and the continuous type was found in five patients (31.2%). Six cases were associated with ossification of the ligamentum flavum, and two cases were combined with cervical OPLL. The OPLL area at the CD level increased in all patients. The mean follow-up period was 5.5 AE 0.92 years (range 5-8 years). The mean area of ossification increased from 35.63 AE 39.23 mm 2 at the time of surgery to 99.94 AE 65.39 mm 2 at the last follow-up visit (P < 0.01). There was no internal fixation disorder on any computed tomography scan after the operation. The average JOA score of all patients improved from 4.2 AE 2.2 points before surgery to 8.4 AE 2.6 points at the final follow-up (P < 0.01). The overall HRR was 61.8%. None of the patients exhibited any neurological deterioration due to OPLL progression. One patient developed a severe gait disturbance due to worsening lumbar canal stenosis, an unrelated cause, but the other 15 experienced gait disturbance improvements.Conclusions: According to the long-term follow-up results, although OPLL progression did not decrease or stop after removing the OPLL mass, CD is a safe and effective procedure that can provide adequate reserve ventral space to cope with postoperative OPLL progression.

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Risk factors for progression of ossification of the posterior longitudinal ligament in asymptomatic subjects

Cited by 15 publications

References 26 publications

Clinical Risk Factors for Thoracic Ossification of the Ligamentum Flavum: A Cross-Sectional Study Based on Spinal Thoracic Three-Dimensional Computerized Tomography

Clinical Risk Factors for Thoracic Ossification of the Ligamentum Flavum: A Cross-Sectional Study Based on Spinal Thoracic Three-Dimensional Computerized Tomography

Close Association Between Non-Alcoholic Fatty Liver Disease and Ossification of the Posterior Longitudinal Ligament of the Spine

Long‐Term Follow‐Up of Multilevel Thoracic Ossification of the Posterior Longitudinal Ligament Following Circumferential Decompression via Posterior Approach: A Retrospective Study

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