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

View More View Less
  • 1 Department of Orthopaedic Surgery, University of Tokyo; and
  • 2 Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The incidence and risk factors for the progression of ossification of the posterior longitudinal ligament (OPLL) have been previously reported in surgically and nonsurgically treated symptomatic patients. However, the correlates of OPLL progression in asymptomatic subjects with OPLL are not well characterized. This study aimed to clarify the incidence and risk factors for OPLL progression in asymptomatic subjects based on whole-body CT.

METHODS

The authors retrospectively reviewed 2585 healthy subjects who underwent whole-body CT at a single health center from September 2007 to December 2011. This study included asymptomatic subjects with OPLL who underwent CT scans twice with an interval of at least 5 years. Progression of OPLL was assessed based on initial and final CT scan. Subjects were divided into two groups: nonprogression (OPLL-NP) and progression (OPLL-P) groups. Clinical characteristics, bone mineral density status, OPLL types, and OPLL involvement of multiple vertebral levels between the two groups were compared. Risk factors for progression of OPLL were identified by logistic regression analysis after propensity score adjustment.

RESULTS

Of the 109 subjects with OPLL (91 men and 18 women), 20 (18.3%) exhibited OPLL progression (OPLL-P group). Subjects in the OPLL-P group were significantly younger (p = 0.031), had higher prevalence of multilevel OPLL involvement (p = 0.041) and continuous type of OPLL (p = 0.015), and had higher uric acid (UA) levels (p = 0.004) at the time of initial CT examination compared to the OPLL-NP group. Younger age (adjusted odds ratio [aOR] 0.95, 95% CI 0.90–0.99), OPLL involvement of multiple vertebral levels (aOR 2.88, 95% CI 1.06–7.83), continuous type of OPLL (aOR 4.21, 95% CI 1.35–13.10), and higher UA levels (aOR 2.09, 95% CI 1.24–3.53) were significant risk factors for OPLL progression.

CONCLUSIONS

Younger age, OPLL involvement of multiple vertebral levels, continuous type of OPLL, and higher UA levels are significant risk factors for OPLL progression in asymptomatic subjects.

ABBREVIATIONS aOR = adjusted odds ratio; BMD = bone mineral density; BUA = broadband ultrasound attenuation; HbA1c = glycosylated hemoglobin; HDL = high-density lipoprotein; LDL = low-density lipoprotein; OPLL = ossification of the posterior longitudinal ligament; OPLL-NP = OPLL nonprogression; OPLL-P = OPLL progression; QUS = quantitative ultrasonography; SOS = speed of sound; TC = total cholesterol; TG = triglyceride; UA = uric acid.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Yasushi Oshima: University of Tokyo, Japan. yoo-tky@umin.ac.jp.

INCLUDE WHEN CITING Published online May 8, 2020; DOI: 10.3171/2020.3.SPINE2082.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Fujimori T, Le H, Hu SS, Ossification of the posterior longitudinal ligament of the cervical spine in 3161 patients: a CT-based study. Spine (Phila Pa 1976). 2015;40(7):E394E403.

    • Search Google Scholar
    • Export Citation
  • 2

    Wang L, Jiang Y, Li M, Qi L. Postoperative progression of cervical ossification of posterior longitudinal ligament: a systematic review. World Neurosurg. 2019;126:593600.

    • Search Google Scholar
    • Export Citation
  • 3

    Matsunaga S, Sakou T. Ossification of the posterior longitudinal ligament of the cervical spine: etiology and natural history. Spine (Phila Pa 1976). 2012;37(5):E309E314.

    • Search Google Scholar
    • Export Citation
  • 4

    Onji Y, Akiyama H, Shimomura Y, Posterior paravertebral ossification causing cervical myelopathy. A report of eighteen cases. J Bone Joint Surg Am. 1967;49(7):13141328.

    • Search Google Scholar
    • Export Citation
  • 5

    Iwasaki M, Okuda S, Miyauchi A, Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 2: Advantages of anterior decompression and fusion over laminoplasty. Spine (Phila Pa 1976). 2007;32(6):654660.

    • Search Google Scholar
    • Export Citation
  • 6

    Fujimori T, Watabe T, Iwamoto Y, Prevalence, concomitance, and distribution of ossification of the spinal ligaments: results of whole spine CT scans in 1500 Japanese patients. Spine (Phila Pa 1976). 2016;41(21):16681676.

    • Search Google Scholar
    • Export Citation
  • 7

    Yonenobu K. Is surgery indicated for asymptomatic or mildly myelopathic patients with significant ossification of the posterior longitudinal ligament? Spine (Phila Pa 1976). 2012;37(5):E315E317.

    • Search Google Scholar
    • Export Citation
  • 8

    Chiba K, Yamamoto I, Hirabayashi H, Multicenter study investigating the postoperative progression of ossification of the posterior longitudinal ligament in the cervical spine: a new computer-assisted measurement. J Neurosurg Spine. 2005;3(1):1723.

    • Search Google Scholar
    • Export Citation
  • 9

    Choi BW, Baek DH, Sheffler LC, Chang H. Analysis of progression of cervical OPLL using computerized tomography: typical sign of maturation of OPLL mass. J Neurosurg Spine. 2015;23(5):539543.

    • Search Google Scholar
    • Export Citation
  • 10

    Hori T, Kawaguchi Y, Kimura T. How does the ossification area of the posterior longitudinal ligament thicken following cervical laminoplasty? Spine (Phila Pa 1976). 2007;32(19):E551E556.

    • Search Google Scholar
    • Export Citation
  • 11

    Iwasaki M, Kawaguchi Y, Kimura T, Yonenobu K. Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg. 2002;96(2)(suppl):180189.

    • Search Google Scholar
    • Export Citation
  • 12

    Kawaguchi Y, Kanamori M, Ishihara H, Progression of ossification of the posterior longitudinal ligament following en bloc cervical laminoplasty. J Bone Joint Surg Am. 2001;83(12):17981802.

    • Search Google Scholar
    • Export Citation
  • 13

    Lee CH, Sohn MJ, Lee CH, Are there differences in the progression of ossification of the posterior longitudinal ligament following laminoplasty versus fusion? A meta-analysis. Spine (Phila Pa 1976). 2017;42(12):887894.

    • Search Google Scholar
    • Export Citation
  • 14

    Lee DH, Cho JH, Kim NH, Radiological risk factors for progression of ossification of posterior longitudinal ligament following laminoplasty. Spine J. 2018;18(7):11161121.

    • Search Google Scholar
    • Export Citation
  • 15

    Ogawa Y, Toyama Y, Chiba K, Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg Spine. 2004;1(2):168174.

    • Search Google Scholar
    • Export Citation
  • 16

    Katsumi K, Watanabe K, Izumi T, Natural history of the ossification of cervical posterior longitudinal ligament: a three dimensional analysis. Int Orthop. 2018;42(4):835842.

    • Search Google Scholar
    • Export Citation
  • 17

    Matsunaga S, Sakou T, Hayashi K, Trauma-induced myelopathy in patients with ossification of the posterior longitudinal ligament. J Neurosurg. 2002;97(2)(suppl):172175.

    • Search Google Scholar
    • Export Citation
  • 18

    Matsunaga S, Sakou T, Taketomi E, Komiya S. Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study. J Neurosurg. 2004;100(3)(Suppl Spine):245248.

    • Search Google Scholar
    • Export Citation
  • 19

    Park S, Lee DH, Ahn J, How does ossification of posterior longitudinal ligament progress in conservatively managed patients? Spine (Phila Pa 1976). 2020;45(4):234243.

    • Search Google Scholar
    • Export Citation
  • 20

    Takatsu T, Ishida Y, Suzuki K, Inoue H. Radiological study of cervical ossification of the posterior longitudinal ligament. J Spinal Disord. 1999;12(3):271273.

    • Search Google Scholar
    • Export Citation
  • 21

    Yoshimura N, Nagata K, Muraki S, Prevalence and progression of radiographic ossification of the posterior longitudinal ligament and associated factors in the Japanese population: a 3-year follow-up of the ROAD study. Osteoporos Int. 2014;25(3):10891098.

    • Search Google Scholar
    • Export Citation
  • 22

    Tokuhashi Y, Ajiro Y, Umezawa N. A patient with two re-surgeries for delayed myelopathy due to progression of ossification of the posterior longitudinal ligaments after cervical laminoplasty. Spine (Phila Pa 1976). 2009;34(2):E101E105.

    • Search Google Scholar
    • Export Citation
  • 23

    Tsuyama N. Ossification of the posterior longitudinal ligament of the spine. Clin Orthop Relat Res. 1984;(184):7184.

  • 24

    Shingyouchi Y, Nagahama A, Niida M. Ligamentous ossification of the cervical spine in the late middle-aged Japanese men. Its relation to body mass index and glucose metabolism. Spine (Phila Pa 1976). 1996;21(21):24742478.

    • Search Google Scholar
    • Export Citation
  • 25

    Perez-Ruiz F, Dalbeth N, Bardin T. A review of uric acid, crystal deposition disease, and gout. Adv Ther. 2015;32(1):3141.

  • 26

    Resnick D, Shapiro RF, Wiesner KB, Diffuse idiopathic skeletal hyperostosis (DISH) [ankylosing hyperostosis of Forestier and Rotes-Querol]. Semin Arthritis Rheum. 1978;7(3):153187.

    • Search Google Scholar
    • Export Citation
  • 27

    Kiss C, Szilágyi M, Paksy A, Poór G. Risk factors for diffuse idiopathic skeletal hyperostosis: a case-control study. Rheumatology (Oxford). 2002;41(1):2730.

    • Search Google Scholar
    • Export Citation
  • 28

    Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013;9(12):741750.

    • Search Google Scholar
    • Export Citation
  • 29

    Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85(3):257268.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 141 140 140
Full Text Views 58 58 58
PDF Downloads 31 31 31
EPUB Downloads 0 0 0