Distinct progression pattern of ossification of the posterior longitudinal ligament of the thoracic spine versus the cervical spine: a longitudinal whole-spine CT study

View More View Less
  • 1 Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido; and
  • | 2 Department of Orthopedics, Hakodate Central General Hospital, Hokkaido, Japan
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

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

USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

Data regarding risk factors for the progression of ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine are scarce. Therefore, in this study, the authors aimed to elucidate the difference in the radiographic progression pattern of OPLL and its risk factors between cervical and thoracic OPLL using longitudinally acquired whole-spine CT scans.

METHODS

Overall, 123 patients with symptomatic OPLL who underwent repeated whole-spine CT examinations, with an average interval of 49 months (at least 3 years) between scans, were retrospectively reviewed. Progression of OPLL was assessed to compare the distribution of OPLL over the entire spine on the initial and final CT scans. Patients were divided into a cervical OPLL (C-OPLL) group and a thoracic OPLL (T-OPLL) group according to the location of the main lesion. The progression pattern of OPLL and its risk factors were compared between the two groups using the Student t-test or Mann-Whitney U-test.

RESULTS

In the C-OPLL group, 15 (22.1%) of 68 patients had OPLL progression, of whom 12 patients (80.0%) had progression only in the cervical spine and 3 patients (20.0%) had progression in multiple regions (cervical and thoracic/lumbar). In the T-OPLL group, 16 (29.1%) of 55 patients had OPLL progression, of which 3 patients (18.8%) had progression only in the thoracic spine and 8 patients (50.0%) had progression in multiple regions. Young age was a common risk factor for OPLL progression regardless of the location of OPLL, and this trend was more pronounced in the T-OPLL group than in the C-OPLL group. High BMI, male sex, and multilevel, severe T-OPLL were identified as independent risk factors for progression of T-OPLL (OR 1.19, 95% CI 1.03–1.37; OR 10.5, 95% CI 1.39–81.94; and OR 1.24, 95% CI 1.16–1.45, respectively).

CONCLUSIONS

Patients with T-OPLL are predisposed to diffuse progression of OPLL over the entire spine, whereas patients with C-OPLL are likely to have progression in only the cervical spine. Young age and high BMI are significant risk factors for OPLL progression, especially in patients with T-OPLL. Our study highlights the need for continued follow-up in patients with T-OPLL, especially in young patients and those with obesity, for early detection of spinal cord and cauda equina symptoms due to the progression of OPLL throughout the spine.

ABBREVIATIONS

C-OPLL = cervical OPLL; ICC = intraclass correlation coefficient; NP = nonprogression; OALL = ossification of the anterior longitudinal ligament; OLF = ossification of the ligamentum flavum; OPLL = ossification of the posterior longitudinal ligament; P = progression; T-OPLL = thoracic OPLL.

Supplementary Materials

    • Supplemental Tables and Figure (PDF 1,359 KB)

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

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

USD  $612.00
  • 1

    Fujimori T, Le H, Hu SS, et al. 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.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Endo T, Takahata M, Koike Y, Iwasaki N. Clinical characteristics of patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament. J Bone Miner Metab. 2020;38(1):6369.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Hirai T, Yoshii T, Iwanami A, et al. Prevalence and distribution of ossified lesions in the whole spine of patients with cervical ossification of the posterior longitudinal ligament a multicenter study (JOSL CT study). PLoS One. 2016;11(8):e0160117.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Mori K, Imai S, Kasahara T, Nishizawa K, Mimura T, Matsusue Y. Prevalence, distribution, and morphology of thoracic ossification of the posterior longitudinal ligament in Japanese: results of CT-based cross-sectional study. Spine (Phila Pa 1976). 2014;39(5):394399.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Park JY, Chin DK, Kim KS, Cho YE. Thoracic ligament ossification in patients with cervical ossification of the posterior longitudinal ligaments: tandem ossification in the cervical and thoracic spine. Spine (Phila Pa 1976). 2008;33(13):E407E410.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    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.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Doi T, Sakamoto R, Horii C, et al. Risk factors for progression of ossification of the posterior longitudinal ligament in asymptomatic subjects. J Neurosurg Spine. 2020;33(3):316322.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Fargen KM, Cox JB, Hoh DJ. Does ossification of the posterior longitudinal ligament progress after laminoplasty? Radiographic and clinical evidence of ossification of the posterior longitudinal ligament lesion growth and the risk factors for late neurologic deterioration. J Neurosurg Spine. 2012;17(6):512524.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Hori T, Kawaguchi Y, Kimura T. How does the ossification area of the posterior longitudinal ligament progress after cervical laminoplasty? Spine (Phila Pa 1976). 2006;31(24):28072812.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

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

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

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

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Kawaguchi Y, Matsumoto M, Iwasaki M, et al. New classification system for ossification of the posterior longitudinal ligament using CT images. J Orthop Sci. 2014;19(4):530536.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Kawaguchi Y, Nakano M, Yasuda T, Seki S, Hori T, Kimura T. Ossification of the posterior longitudinal ligament in not only the cervical spine, but also other spinal regions: analysis using multidetector computed tomography of the whole spine. Spine (Phila Pa 1976). 2013;38(23):E1477E1482.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Yang X, Liu X, Liang C, Yu M, Liu X, Liu Z. Three-dimensional analysis of the radiological risk factors for progression of the thoracic ossification of the posterior longitudinal ligament after posterior decompression and stabilization. World Neurosurg. 2020;134:e739e746.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Endo T, Imagama S, Kato S, et al. Association between vitamin A intake and disease severity in early-onset heterotopic ossification of the posterior longitudinal ligament of the spine. Global Spine J. Published online January 25, 2021.doi:10.1177/219256822198930.

    • Search Google Scholar
    • Export Citation
  • 18

    Chiba K, Yamamoto I, Hirabayashi H, et al. 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.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Katsumi K, Izumi T, Ito T, Hirano T, Watanabe K, Ohashi M. Posterior instrumented fusion suppresses the progression of ossification of the posterior longitudinal ligament: a comparison of laminoplasty with and without instrumented fusion by three-dimensional analysis. Eur Spine J. 2016;25(5):16341640.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Ota M, Furuya T, Maki S, et al. Addition of instrumented fusion after posterior decompression surgery suppresses thickening of ossification of the posterior longitudinal ligament of the cervical spine. J Clin Neurosci. 2016;34:162165.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Ando K, Imagama S, Kobayashi K, et al. Comparative study of surgical treatment and nonsurgical follow up for thoracic ossification of the posterior longitudinal ligament: radiological and clinical evaluation. Spine (Phila Pa 1976). 2017;42(6):407410.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Sugita S, Chikuda H, Takeshita K, Seichi A, Tanaka S. Progression of ossification of the posterior longitudinal ligament of the thoracic spine following posterior decompression and stabilization. J Neurosurg Spine. 2014;21(5):773777.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 647 647 116
Full Text Views 68 68 12
PDF Downloads 89 89 12
EPUB Downloads 0 0 0