Longitudinal Ligament Of Cervical Spine Research Articles

Ossification of Posterior Longitudinal Ligament in Cervical Spine and Its Association With Ossified Lesions in the Whole Spine: A Cross-Sectional Study of 2500 CT Scans.

A retrospective study. To identify the prevalence and characteristics of ossified posterior longitudinal ligament (OPLL) in the cervical spine and its association with other spinal ligament ossifications. This study is a retrospective review of whole spine CT scans of polytrauma patients from 2009 to 2018. Patients were screened for cervical OPLL (C-OPLL), thoracolumbar OPLL, thoracic ossified ligamentum flavum (OLF), cervical and thoracolumbar ossified anterior longitudinal ligament (C-OALL AND T-L OALL), ossified nuchal ligament (ONL) and, diffuse idiopathic skeletal hyperostosis (DISH) using CT scans. Their prevalence and distributions were assessed using statistical tools. Chi-square tests were used to determine statistical association between the categorical parameters. Out of 2500 patients, 128 had C-OPLL with a prevalence rate of 5.12% with mean age of 55.89 year. The most commonly affected level was C5, followed by C6, and C4. The segmental OPLL was highest in number (77.7%), followed by localized type (14.8%). While the prevalence rate of thoracic OPLL was 0.56%, OLF was 9.9%. Ossifications that coexisted along with C-OPLL were thoracic OPLL (7.81%), thoracic OLF (36.71%), cervical OALL (29.68%), thoracolumbar OALL (37.5%), DISH (27.34%) and, ONL (7.03%). Our study indicated a prevalence rate of 5.12% for C-OPLL with a predominance of segmental OPLL (77.7%). Among these patients, approximately 36% had coexisting thoracic OLF. In patients with symptomatic OPLL induced cervical myelopathy, MRI analysis of whole spine with relevant CT correlation may help in detecting additional ossification sites of compression.

Deep learning algorithm based on analyzing the effect of posterior cervical vertebral canal decompression angioplasty in the treatment of ossification of posterior longitudinal ligament of cervical spine by CT image.

Objective:The paper uses the convolutional neural network algorithm in the deep learning algorithm to explore the therapeutic effect of surgical treatment of hyperextension injuries associated with ossification of the posterior longitudinal ligament of the cervical spine.Methods:In this retrospectively analyzed study 27 patients with hyperextension injury of the posterior longitudinal ligament of the cervical spine were selected from our hospital between August 2018 to July 2020. It included 21 males and 6 females; aged 36-79 years, with an average of 55.9 years.Results:Follow-up time of patients was 3-39 months, with an average of 17.4 months. The JOA score after surgery was significantly better than that before surgery (P<0.01), which was statistically significant; the improvement of JOA in patients undergoing anterior therapy was better than that in patients undergoing posterior therapy, which was statistically significant; the JOA improved in patients with minor violent injuries. The situation is significantly better than severe violent injuries, with statistical significance. The rate of postoperative JOA improvement was significantly correlated with the degree of nerve function retention of the injured spinal cord before surgery (P<0.01), and there was no significant correlation between the degree of spinal stenosis caused by ossification and the postoperative JOA improvement of patients.Conclusion:Convolutional neural network algorithm in the deep learning algorithm based on the cervical spine posterior longitudinal ligament ossification hyperextension injury was significantly improved after surgery. The less preoperative neurological damage, the postoperative neurological function, the degree of improvement, there was no significant correlation between the degree of spinal stenosis and the improvement of postoperative spinal cord function. For patients with ossification of the posterior longitudinal ligament, if there are neurological symptoms, early surgical treatment is recommended to relieve the compression, so as to prevent irreversible neurological damage caused by trauma.

Does surgical treatment increase the progression of spinal cord injury in patients with ossification of posterior longitudinal ligament of cervical spine? A systematic review and meta-analysis.

The purpose of this study is to explore if the surgical treatment will accelerate the progression of spinal cord injury (SCI) in patients with cervical Ossification of the posterior longitudinal ligament (OPLL) and if surgery will have better curative effect than conservative treatment. An extensive search of literature was implemented in PubMed, EMBASE, and other online databases. The quality of the included articles was evaluated according to the Newcastle-Ottawa Quality Assessment Scale, as recommended by the Cochrane manual, and meta-analysis was performed using the review manage5.3 software. No obvious statistical difference was observed in the rate of SCI progression (P > 0.05, OR 1.15 [0.66, 2.00]), cervical range of motion, (P > 0.05, weighted mean difference (WMD) 4.52 [-5.75, 14.79]), and Japanese Orthopedic Association scores before surgery (P > 0.05, WMD -2.78 [-7.87, 2.32]) between the surgical group and conservative treatment group. However the surgical group illustrated obviously higher neurofunctional recovery rate (P < 0.05, OR 6.07 [1.55, 23.78]) and postoperative JOA score of the surgery group (P < 0.05, WMD -0.77 [-1.21, -0.33]) than conservative group. Based on this meta-analysis, there is not enough evidence to indicate that surgery will accelerate the progress of SCI with OPLL. However, the superiority of surgical efficacy can be observed over conservative treatment in terms of relieving neurological symptoms.

Diffuse idiopathic skeletal hyperostosis presenting as cervical and thoracic myelopathy

Introduction: Diffuse idiopathic skeletal hyperostosis (DISH), also termed Forestier’s disease, occurs in about 12% of middle-age and elderly men.1 Anterolateral ossification of the anterior longitudinal ligament leads to ankylosing hyperostosis of continuous vertebral bodies. Neurological problems due to Ossification of Posterior Longitudinal Ligament [OPLL] or Ossification of Ligamentum Flavum [OLF] associated with DISH have been reported. Case Report: A 42 year old male presented with insidious onset neck pain restriction of neck and back movements of 1 year duration. For last 2 weeks presented with weakness and sensory symptoms of both lower. On examination was found to have features of cervical myeloradiculopathy. He was found to have bridging ossification of cervical and thoracic vertebrae in X Ray. MRI showed ossification of posterior longitudinal ligament in cervical spine and ossification of ligamentum flavum in thoracic spine causing compressive myelopathy. He was diagnosed to have DISH with OPLL and OLF causing cervical and thoracic compressive myelopathy. Keywords: Diffuse idiopathic skeletal hyperostosis, Ossification of posterior longitudinal ligament, Cervical myeloradiculopathy, Ossification of ligamentum flavum.

Diagnosis of Neuropathy of Cervical Posterior Longitudinal Ligament by Medical Imaging Technology

The patients were evaluated by the International Orthopaedic Association evaluation method and graded and correlated by medical imaging technology. The results showed that 41% of the patients had unstable gait and sensory loss of lower limbs or muscle weakness in the analysis of clinical manifestations. In the analysis of therapeutic effect by using medical imaging technology, it was found that the patients’ scores increased significantly after operation, which was significantly different from those before operation (P &lt; 0.01). There was a significant correlation between preoperative scores and imaging changes, but no significant correlation between other indicators after surgery. Therefore, through the study, it is found that the application of medical imaging technology in the observation and treatment of ossification of the posterior longitudinal ligament of cervical spine can play a very positive and accurate role in the analysis of the patient’s condition, and provide an experimental basis for the selection of treatment methods for ossification of the posterior longitudinal ligament of cervical spine and the application direction of medical imaging technology.

Ossification of Posterior Longitudinal Ligament of Cervical Spine Among Omani Patients Referred for CT Scan at a Tertiary Care Hospital in Oman.

ObjectivesWe sought to evaluate the proportion of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine and associated factors among Omani patients.MethodsWe reviewed the cervical spine computed tomography (CT) scans of all patients referred to the Radiology Department, Sultan Qaboos University Hospital, from 2011 to 2017. Descriptive statistics were employed to determine the proportion of OPLL. We used the chi-square test to determine the association of age, gender, and diabetes mellitus with OPLL.ResultsA total of 843 patients aged ≥ 20 years were included in the study. The proportion of OPLL was 2.7% and was more frequent in men (3.2%) than women (1.9%). The male to female ratio of OPLL was 1.7:1.0. OPLL occurrence was significantly more in non-diabetic patients (p < 0.001). No significant association was found between OPLL with gender (p = 0.281) and age (p = 0.878).ConclusionsThe observed proportion of OPLL in this single-center study is relatively low, but the finding is important as the condition can eventually lead to debilitating neurologic outcomes affecting the patient’s quality of life. OPLL occurrence was significantly more in non-diabetic patients, which necessitate further research on OPLL in a larger sample across Oman.

Quantitative study of the effect of atlas posterior arch resection on cervical posterior decompression

Objective To quantitatively compare the effect of preservation or removal of atlas posterior arch on cervical posterior decompression, so as to provide a basis for reasonable selection of upper cervical spine decompression range and determination of surgical indications for atlas posterior arch resection. Methods The data of 45 patients with posterior decompression of upper cervical spine were retrospectively analyzed. According to the decompression range, the patients were divided into C2-C7 group and C1-C7 group. There were 25 cases in the C2-C7 group, 19 males and 6 females, with an average age of 56.3 years (40-71 years), 4 cases of cervical spondylotic myelopathy and 21 cases of ossification of the posterior longitudinal ligament of cervical spine. All of the 25 patients underwent open-door laminoplasty: 20 cases with hinge side anchoring procedure and 5 cases with preservation of the unilateral posterior muscular-ligament complex procedure (titanium cable procedure). There were 20 cases in C1-C7 group, 12 males and 8 females, with an average age of 58.4 years (44-75 years). All of the 20 cases underwent atlas posterior arch resection as well as C2-C7 open-door laminoplasty, including anchoring procedure in 1 case, titanium miniplate procedure in 4 cases, and titanium cable procedure in 15 cases. Standardized vertebral-cord distance (SVCD) at each level from atlas to level C6,7 was measured on T2-weighted images of MR on the mid-sagittal plane in the neutral position performed 3-12 months postoperatively at each individual level. As the main outcomes, the SVCD values obtained at the same level of the two groups were compared between the two groups. Shapiro-Wilk normality test was performed on the SVCD values at C1,2 and C2 levels of two groups. The area under the normal distribution curve of SVCDs was used to calculate the corresponding residual compression rate with different magnitude of compression mass to further discover the difference of the decompression effect between the two groups. Results The SVCD obtained at the level of the anterior arch of atlas (C1), the junction of odontoid process and axis (C1,2) and the middle part of axis body (C2) in the C2-C7 group was 9.91±1.34 mm, 8.35±1.27 mm, and 8.22 ±1.43 mm, respectively. The SVCD at the same levels was 11.02±1.60 mm, 9.72±1.24 mm, and 9.12±1.11 mm, respectively. SVCDs differed significantly in the above range between the two groups. However, from level C2,3 to C6,7, there was no significant difference in SVCDs between the two groups. The JOA score of group C2-C7 was 11.8±2.7 preoperatively and increased significantly to 14.7±1.8 at 12 months postoperatively(t=-7.006, P<0.001) with a recovery rate of 57.0%±32.2%. The JOA score of group C1-C7 was 11.7±2.8 preoperatively and increased significantly to 14.2±2.3 at 12 months postoperatively(t=-6.177, P<0.001) with a recovery rate of 51.9%±32.1%. Conclusion Atlas posterior arch resection can significantly increase the decompression effect of posterior cervical surgery from the anterior arch of atlas to the middle part of axis body, but it would not increase the decompression effect at level C2,3 or below. When the magnitude of the ventral compression factor exceeds the decompression limit (8.5 mm) available with C2-C7 decompression in the range from atlas to the middle of the axis body, extending the decompression range by atlas posterior arch resection is an effective means to achieve adequate decompression. Key words: Cervical atlas; Axis; Ossification of posterior longitudinal ligament; Spinal cord compression; Decompression, surgical

Safety and effectiveness of ultrasonic osteotome in posterior cervical laminectomy decompression and fusion

To explore the safety of ultrasonic osteotome used in posterior cervical laminectomy decompression surgery and its effect on surgical outcome. A clinical data of 52 patients with ossification of posterior longitudinal ligament of cervical spine (C-OPLL) undergoing posterior cervical laminectomy decompression and fusion (PCLDF) between April 2013 and April 2017 was retrospectively analysed. The patients were divided into two groups according to whether using the ultrasonic osteotome during operation: group A (20 cases, ultrasonic osteotome group) and group B (32 cases, traditional gun-clamp decompression group). There was no significant difference in gender, age, body weight, height, preoperative hemoglobin, and Japanese Orthopedic Association (JOA) score between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time, complications, hemoglobin at 1 day after operation, and JOA score at 6 months after operation were recorded and compared between the two groups, and the improvement rate of JOA was calculated. The operation time and intraoperative blood loss in group A were significantly less than those in group B ( P<0.05); there was no significant difference in the drainage volume and hospitalization time between the two groups ( P>0.05). The hemoglobin of group B was slightly higher than that of group A at 1 day after operation, but there was no significant difference between the two groups ( t=-1.260, P=0.214). All the patients were followed up 6-10 months (mean, 7.6 months). No serious complications such as C 5 nerve paralysis, dural tear, infection, epidural hematoma, deep venous thrombosis, pulmonary embolism, transfusion allergy, or shock occurred during and after operation. The JOA scores of the two groups were significant improved at 6 months after operation when compared with preoperative scores ( P<0.05), and there was no significant difference in JOA score and improvement rate between the two groups at 6 months after operation ( P>0.05). Compared with the traditional gun-clamp decompression, the effectiveness of PCLDF in treatment of C-OPLL by using ultrasonic osteotome is comparable, but the latter can effectively reduce the operation time and blood loss.

Ossification of the Posterior Longitudinal Ligament in Cervical Spine: Prevalence, Management, and Prognosis.

Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine and related neurological complications are not uncommon in East Asian countries. The estimated prevalence of cervical OPLL-related hospitalization is 7.7 per 100,000 person-years in Taiwan, and higher incidence rates have been observed in elderly and male patients. Although cervical OPLL is frequently insidious, it can eventually cause myelopathy and predispose patients to spinal cord injury (SCI). There are multiple options for managing cervical OPLL, ranging from observation to many kinds of surgical procedures, including posterior laminoplasty, laminectomy with or without fusion, anterior corpectomy with or without instrumentation, and circumferential decompression and fusion. None of these surgical approaches is free of complications. However, to date, there is still a lack of consensus regarding the choice of the surgical approach and the timing of surgical intervention. Cervical SCI and related neurological disabilities are more likely to occur in OPLL patients, who should therefore be cautioned regarding the possibility of a subsequent SCI if treated without surgery. This article aimed to review the prevalence, management strategies, and prognosis of cervical OPLL.

To focus on the diagnosis and treatment of ossification of posterior longitudinal ligament of cervical spine

颈椎后纵韧带骨化症是临床引起颈脊髓压迫症的重要疾病之一，在颈脊髓压迫症患者中约25%伴有不同程度的后纵韧带骨化（ossification of the posterior longitudinal ligament，OPLL）。多数颈椎OPLL患者症状轻微，但在外伤后可突然加重，出现神经功能急剧恶化。颈椎OPLL手术治疗的时机及方法选择目前尚有争议。本文将讨论颈椎OPLL相关诊断要点及各种术式优缺点。

Anterior surgery in selective patients with massive ossification of posterior longitudinal ligament of cervical spine: technical note

The study includes case series, technical note and review of literature. The objective of this study was to assess the validity of the radiographic indicator and the result of anterior operation for massive ossification of posterior longitudinal ligament (MOPLL, ossification of posterior longitudinal ligament with an occupying ratio exceeding 50%). Anterior decompression yielded a better outcome than posterior approach in patients with MOPLL of cervical spine. But anterior surgery has the problem of technically demanding and was associated with a high incidence of surgery-related complications. Many ways for reducing the risk of anterior surgery have been reported, including floating method, employing microscopes or burrs, and laser-assisted corpectomy. A case series of selective patients with MOPLL of cervical spine undergoing anterior surgery is reported. All patients were strictly selected based on CT images with the appearance of open-base. 29 cases with more than 12 months follow-up (average, 31.0 ± 10.0 m) were reviewed. Average age at operation was 59.3 ± 8.2 years (43-73 years). Anterior decompression was done only for one or two vertebrae. One corpectomy was done in 13 cases, two corpectomies in 3 cases, and one corpectomy and one discectomy in 13 cases. Three levels were fused in 16 cases and two levels in 13 cases. No permanent neurological deterioration was observed. Neurological improvement was observed in every patients with an average improvement rate of 64 ± 23%. Mesh migration was observed in one case. A fusion rate of 100% was achieved. Anterior surgery using our technique may be a relatively simple and safe procedure in selective patients with massive ossification of posterior longitudinal ligament of cervical spine.

A review of prognostic factors for surgical outcome of ossification of the posterior longitudinal ligament of cervical spine

For patients with ossification of the posterior longitudinal ligament (OPLL) who have neurological-symptoms, surgery is necessary but not always effective. Various clinical factors influence the surgical outcome. The studies identifying these factors have been inconclusive and conflicting. It is essential for surgeons to understand the significance of the factors and choose the optimal therapeutic strategy for OPLL. The objective of this review is to determine the clinical factors predictive of the surgical outcome of cervical OPLL. The authors conducted a review of literature published in the English language. They examined studies in which the correlation between clinical factors and outcome were statistically evaluated. The results showed that the traverse area of the spinal cord, the spinal cord-evoked potentials (SCEPs), the increase of the range of motion in the cervical spine (ROM), diabetes, history of trauma, the onset of ossification of the ligament flavum (OLF) in the thoracic spine, snake-eye appearance (SEA) and incomplete decompression may be predictive factors. Age at surgery seems to be closely related to the outcome of posterior surgical procedure. Whether the neurological score, OPLL type, pre-operative duration of symptoms, focal intra-medullar high signal intensity in T2-weighted (IMHSI) and progression of OPLL or kyphosis and expansion of the spinal canal predict the surgical outcome remains unclear. The use of uniform neurological score and proper statistic analysis should facilitate comparison of data from different studies. It is important to analyze the effect of each factor on groups with different surgical procedures as well as patients with different compressive pathology. Research on the etiology and pathology of cervical myelopathy due to OPLL should be helpful in precisely understanding these clinical factors and predicting surgical outcome.

Characteristics of Ossified Lesions in the Upper Cervical Spine Associated with Ossification of the Posterior Longitudinal Ligament in the Lower Cervical Spine

Ossified lesions of the upper cervical spine behind the dens may cause cervical myelopathy. We investigated the prevalence of ossified lesions in patients with ossification of the posterior longitudinal ligament in order to clarify the characteristics of these patients. Fifty-six consecutive patients with ossification of the posterior longitudinal ligament in the cervical spine were included in the study. Multidetector computed tomography images of the whole spine were made. Ossified lesions of the upper cervical spine were defined as ossified lesions behind the dens as seen on axial computed tomography images. The prevalence of ossified lesions at the first cervical level was analyzed. The clinical and radiographic parameters were compared between the patients with ossified lesions at the first cervical level and the patients without such lesions. Fourteen patients (25%) had ossified lesions of the upper cervical spine. The continuous type of ossification of the posterior longitudinal ligament in the lower cervical spine was common and the segmental type was rare in this group as compared with the types of ossification in the group without ossified lesions at the first cervical level. The patients with first cervical level ossification more frequently had ossification of the posterior longitudinal ligament in the thoracic and/or lumbar spine, compared with the patients without upper cervical ossification. One patient had cervical myelopathy as a result of the upper cervical ossified lesion. Computed tomography imaging demonstrated the presence of ossified lesions behind the dens in 25% of patients with subaxial ossification of the posterior longitudinal ligament. These upper cervical ossified lesions were commonly seen in patients with multiple-level ossification of the posterior longitudinal ligament. When upper cervical ossified lesions cause severe narrowing of the spinal canal, they should be considered a potential cause of cervical myelopathy.

Examination about the shape of the ossification of the posterior longitudinal ligament of cervical spine with three dimentional CT

Examination about the shape of the ossification of the posterior longitudinal ligament of cervical spine with three dimentional CT

P14. Middle and longterm follow up outcomes of laminoplasty for patients with ossification of the posterior longitudinal ligament of cervical spine

P14. Middle and longterm follow up outcomes of laminoplasty for patients with ossification of the posterior longitudinal ligament of cervical spine

Messenger RNA expression of the genes encoding receptors for bone morphogenetic protein (BMP) and transforming growth factor-β (TGF-β) in the cells from the posterior longitudinal ligament in cervical spine

Posterior longitudinal ligament (PLL) in cervical spine is one of the sites of ossification in idiopathic hyperostotic diseases. Although the mechanism of the pathological triggering of the disease has not yet been clarified, the cells in PLL have been reported to express osteotropic cytokines such as BMP-2 and TGF-β. However, it has not been known whether the cells in PLL express receptors for these cytokines. We examined the expression of the messenger RNAs of the genes encoding receptors for BMP-2/4 and TGF-β in the PLL cells. Tissues from three OPLL (ossification of the posterior longitudinal ligament) patients who underwent anterior decompression surgery with removal of the ossified PLL were dissected microscopically and were subjected to explant cultures; the cells outgrown from the explants were examined. Type I BMP receptor (BMPR) mRNA was expressed at moderate levels in the cells derived from both ossifying PLL tissues as well as nonossifying adjacent fibrous tissues. Type II TGF-β receptor (TβR) mRNA and α1(I) collagen mRNA were also constitutively expressed in these PLL cells from either regions. Treatment with BMP-2 enhanced the expression of BMPR mRNA in five out of ten of the cell cultures, suggesting that functional BMP receptors were expressed in at least a part of the PLL cells. The BMP-2 effect on BMPR was specific since no such enhancement was observed with regard to the levels of TβR mRNA in all of the ten cultures. These results indicated for the first time that mRNAs of the genes encoding receptors for BMP-2/4 and TGF-β were expressed in the cells derived from human PLL cells.

Stenosis of cervical spinal canal due to ossification of posterior longitudinal ligament

Authors present their experience with 36 cases of spinal canal stenosis due to ossification of posterior longitudinal ligament in cervical spine. Ligament ossification extent was found to be local (1 segment) or segmental (2-3 segments). Clinical examination showed cervical myelopathy of various severity. Diagnosis of cervical spinal canal stenosis was determined mainly by CT and MRT. All patients underwent surgical treatment - anterior transcorporal decompression of spinal cord. Positive results were achieved in 34 patients including 22 patients with complete elimination of myelopathy, 9 patients with partial elimination and 3 patients with stopping of the process progression. In 2 patients, surgical procedure was inefficient.

Ossification of Anterior Longitudinal Ligament of Cervical Spine Causing Dysphagia A Case Report

A case of ossification of anterior longitudinal ligament of cervical spine causing dysphagia is reported because of the rarity of the condition.A house-wife aged 52 years was first seen on April, 1, 1983 with the chief complaint of dyshagia of about 9 months' duration. Roentgenograms showed the excessive development of anterior longitudinal ligament of cervical spine at the level of C-3 to C-7. The disturbance of passage of contrast medium was also observed at the level of C-3 to C-4 in esophgogram.On April 26, 1983, anterior surgery was performed, in which the anterior bony mass was removed.Complete relief was obtained immediately after surgery and she has been asymptomatic 6 months postoperatively.

Immunohistochemical localization of types I, II, and III collagens in the ossified posterior longitudinal ligament of the human cervical spine.

Immunohistochemical localization of types I, II, and III collagen in the ossified posterior longitudinal ligament of the cervical spine was studied using type-specific anticollagen antibodies. In contrast to the normal ligament which contains both types I and III collagens, the ossified matrix, composed of lamellar bone, contains only type I collagen, except for Haversian canals where type III is located in the inner wall. In the transitional region of preossifying ligaments, types III and I are both present. Type II collagen is present in the hyperplastic matrix of the ligament, and cartilage-like cells surrounded by type II collagen are aligned along nonossified ligaments adjacent to the preossifying region. A possible mechanism of matrix transition during the ossification process is given attention.

Cloward's Anterior Spinal Fusion to the Ossification of Cervical Posterior Longitudinal Ligament

We studied 42 cases with ossification of posterior longitudinal ligament of cervical spine. The instability or narrowing of cervical disk and formation of osteophyte are found in many cases.Cloward's anterior spinal fusion is effective in many cases.We must take notice of the interveriebral disk in the patients who have ossification of cervical posterior longitudinal ligament.