Magnetic resonance imaging findings in ossification of the posterior longitudinal ligament of the cervical spine

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Object. Because of the lack of magnetic resonance (MR) signal from cortical bones, MR imaging is inadequate for diagnosing ossified lesions in the spinal canal. However, MR imaging provides important information on spinal cord morphology and associated soft-tissue abnormality. The purpose of this study is to determine the role of MR imaging in the diagnosis and treatment of patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.

Methods. The authors reviewed MR imaging findings in 42 patients with cervical OPLL who were examined with a superconducting MR imaging system. The types of OPLL reviewed included eight cases of continuous, 21 cases of segmental, and 13 cases of the mixed type. All patients were treated surgically either by anterior (26 cases) or posterior decompression (16 cases).

Conclusions. The T1-weighted images clearly demonstrated the spinal cord deformity caused by OPLL. Associated disc protrusion was found to be present at the maximum compression level in 60% of the patients in this series. The highest incidence of disc protrusion (81%) was found in patients with segmental OPLL. Intramedullary hyperintensity on T2*-weighted imaging was noted in 18 patients (43%). The neurological deficits observed in these 18 patients were significantly more severe than those observed in the other 24 patients. Postoperative MR imaging revealed improvement in the spinal cord deformity, although the intramedullary hyperintensity was still observed in most cases. The present study demonstrates the importance of associated disc protrusion in the development of myelopathy in patients with cervical OPLL. Magnetic resonance imaging findings may be used to help determine the actual levels of spinal cord compression and to suggest the method of surgical treatment.

Article Information

Address reprint requests to: Izumi Koyanagi, M.D., Hokkaido Neurosurgical Memorial Hospital, North 22, West 15, Chuo-Ku, Sapporo, 060, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. a: Conventional sagittal tomogram of the cervical spine demonstrating continuous OPLL from C-3 to C-4. b: Sagittal T1-weighted MR image revealing deformity of the spinal cord due to compression by OPLL at C3–4. c: Postoperative sagittal T1-weighted MR image. The patient underwent corpectomy at C3–4 and anterior fusion from C-2 to C-5 using an iliac bone graft. Good decompression of the spinal cord is visualized.

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    Case 2. a: Conventional sagittal tomogram of the cervical spine showing continuous OPLL at C3–4 and below C-5. Ossification of the anterior longitudinal ligament is also visualized. The spinal canal is narrowed most prominently at the C3–4 level. b: Sagittal T1-weighted MR image demonstrating deformity of the spinal cord from C-4 to C-5 due to compression by OPLL. An area of hyperintensity indicating fatty bone marrow is seen in the ossified ligament at the C3–4 level (arrow). c: Sagittal T2*-weighted MR image. An area of hyperintensity in the spinal cord extends approximately from C-3 to C-6. d: Axial T2*-weighted MR image obtained at the C-4 level demonstrating characteristic intramedullary areas of hyperintensity, indicating cystic degeneration of the gray matter. e: Postoperative radiograph (lateral view) obtained after the patient underwent corpectomy from C-4 to C-5 and anterior fusion from C-3 to C-6 using an iliac bone graft.

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    Case 3. a: Conventional sagittal tomogram of the cervical spine demonstrating segmental OPLL at the C-6 and C-7 levels (arrows). b: Sagittal T1-weighted MR image revealing marked deformity of the spinal cord from C-5 to C-7. Disc protrusion at the C5–6 level (arrow) is found to produce severe spinal cord compression. Deformity of the spinal cord is also noted at the C3–4 level due to anteroposterior compression by the intervertebral disc and the yellow ligament. c: Sagittal T2*-weighted MR image. Intramedullary hyperintensity is noted from C3–4 to C-7. Disc protrusion at the C5–6 level is also demonstrated.

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    Scatterplot graph (left) depicting the relationship between preoperative neurological deficits as scored by the NCSS and spinal cord deformity shown on T1-weighted axial images at the maximum compression level (cord deformity = sagittal diameter/transverse diameter of the spinal cord [right]). Open circles (24 patients) indicate the patients whose T2*-weighted MR images demonstrated normal intramedullary signal intensity, whereas closed circles (18 patients) indicate the patients whose T2*-weighted images demonstrated intramedullary hyperintensity.

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