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William R. Stetler Jr., Frank La Marca, and Paul Park

O ssification of the posterior longitudinal ligament refers to pathological mineralization. This ectopic ossification is slowly progressive, and patients with OPLL can range from asymptomatic to severely myelopathic. 7 , 27 The most common location of OPLL is the cervical spine 43 followed by the thoracic spine, 34 but it can also occur anywhere in the spinal axis. Ossification of the posterior longitudinal ligament is more frequently noted in male patients by a ratio of 2:1, 19 and is more common in East Asian populations, particularly in the Japanese 7

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Christopher J. Stapleton, Martin H. Pham, Frank J. Attenello, and Patrick C. Hsieh

narrowing of spinal canal and cord compression . N Y State J Med 82 : 1193 – 1198 , 1982 2 Furushima K , Shimo-Onoda K , Maeda S , Nobukuni T , Ikari K , Koga H , : Large-scale screening for candidate genes of ossification of the posterior longitudinal ligament of the spine . J Bone Miner Res 17 : 128 – 137 , 2002 3 Goding JW , Grobben B , Slegers H : Physiological and pathophysiological functions of the ecto-nucleotide pyrophosphatase/phosphodiesterase family . Biochim Biophys Acta 1638 : 1 – 19 , 2003 4 Inamasu J , Guiot

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Jamal McClendon Jr., Patrick A. Sugrue, Aruna Ganju, Tyler R. Koski, and John C. Liu

O ssification of the posterior longitudinal ligament is an epidemiological event that often affects the cervical spine. Tsukimoto 32 was the first to describe OPLL of the cervical spine in 1960. However, the condition may involve the thoracic spine and produce myelopathy through anterior spinal cord compression. 16 Ossification of the posterior longitudinal ligament is rarely seen in patients until the third decade of life. 19 This disease process is most commonly seen in the Japanese population. 19 The prevalence of thoracic OPLL seen in a Japanese

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Mario J. Cardoso, Tyler R. Koski, Aruna Ganju, and John C. Liu

interpretation of data: all authors. Drafting the article: Cardoso. Critically revising the article: Cardoso, Liu. Reviewed final version of the manuscript and approved it for submission: all authors. Administrative/technical/material support: all authors. Study supervision: Koski, Liu. References 1 Abe H , Tsuru M , Ito T , Iwasaki Y , Koiwa M : Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine . J Neurosurg 55 : 108 – 116 , 1981 2 Albert TJ , Vacarro A : Postlaminectomy kyphosis . Spine 23

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Atsushi Seichi, Katsushi Takeshita, Hiroshi Kawaguchi, Naohiro Kawamura, Akiro Higashikawa, and Kozo Nakamura

and fusion for thoracic myelopathy resulting from ossification of the posterior longitudinal ligament. Spine 22 : 305 – 311 , 1997 Fujimura Y, Nishi Y, Nakamura M, Toyama Y, Suzuki N: Long-term follow-up study of anterior decompression and fusion for thoracic myelopathy resulting from ossification of the posterior longitudinal ligament. Spine 22: 305–311, 1997 2. Hanai K , Ogikubo O , Miyashita T : Anterior decompression for myelopathy resulting from thoracic ossification of the posterior longitudinal ligament

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Shunji Matsunaga, Makoto Kukita, Kyoji Hayashi, Reiko Shinkura, Chihaya Koriyama, Takashi Sakou, and Setsuro Komiya

11 : 16 – 20 , 1998 Fujimura Y, Nakamura M, Toyama Y: Influence of minor trauma on surgical results in patients with cervical OPLL. J Spinal Disord 11: 16–20, 1998 4. Katoh S , Ikata T , Hirai N , et al : Influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. Paraplegia 33 : 330 – 333 , 1995 Katoh S, Ikata T, Hirai N, et al: Influence of minor trauma to the neck on the neurological outcome in

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Shunji Matsunaga, Takashi Sakou, Kyoji Hayashi, Yasuhiro Ishidou, Masataka Hirotsu, and Setsuro Komiya

O ssification of the posterior longitudinal ligament, a subtype of diffuse idiopathic skeletal hyperostosis, 12, 13 may contribute to the onset of and produce quadriplegia in older individuals. 17, 19 A number of studies 1, 6, 8, 11, 14 of OPLL in the cervical spine have been performed since the publication of the autopsy report by Tsukimoto. 18 Ossification of the posterior longitudinal ligament may contribute to development of myelopathy in elderly individuals. Observation of the natural course of the disease has revealed that the development of

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Izumi Koyanagi, Yoshinobu Iwasaki, Kazutoshi Hida, Hiroyuki Imamura, and Hiroshi Abe

cervical spinal canal and the bulk of the cord, but also on pathological changes that are not revealed by roentgenography alone,” as illustrated by the presence of asymptomatic patients with prominent cervical OPLL and symptomatic patients with relatively small OPLL. Thus, it is important to use state-of-the-art neuroradiological diagnostic modalities in the evaluation of patients with cervical OPLL. Ossification of the posterior longitudinal ligament is clearly demonstrated by conventional tomography. Distribution of OPLL in the spinal canal is accurately visualized

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

O ssification of the posterior longitudinal ligament (OPLL) refers to abnormal ectopic ossification of the posterior longitudinal ligament. OPLL is reportedly more common in males, elderly people, and in the Asian population. 1 , 2 The cervical spine is most commonly affected by OPLL. 3 , 4 OPLL may occasionally cause neurological deficit due to compression of the spinal cord by an ossified ligament. 3 , 4 Patients with severe neurological dysfunction require surgical treatment. 5 OPLL is also incidentally detected in adults during CT for suspected trauma or

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Soo Eon Lee, Chun Kee Chung, Tae-Ahn Jahng, and Hyun-Jib Kim

.1097/01.brs.0000250307.78987.6b 3 Cho WS , Chung CK , Jahng TA , Kim HJ : Post-laminectomy kyphosis in patients with cervical ossification of the posterior longitudinal ligament: does it cause neurological deterioration? . J Korean Neurosurg Soc 43 : 259 – 264 , 2008 10.3340/jkns.2008.43.6.259 4 Deutsch H , Haid RW , Rodts GE , Mummaneni PV : Postlaminectomy cervical deformity . Neurosurg Focus 15 : 3 E5 , 2003 5 Epstein JA : The surgical management of cervical spinal stenosis, spondylosis, and myeloradiculopathy by means of the