reported that COL6A1 was the candidate gene for OPLL (Tsukahara et al., 2005). Ossification of the posterior longitudinal ligament (OPLL) is a condition of heterotopic ossification within the posterior longitudinal ligament. This is a strong sign that the extrusion is not contained within the anulus fibrosis (see Herniated Disc in Chapter 11 and later discussion of Lumbar Intervertebral Discs in this chapter). Extradural intraspinal cysts are a rare cause of lumbosacral radiculopathy, of which seven cases in English literature have been reported secondary to posterior longitudinal ligament (PLL) cyst, the details of which are summarized in [Table - 1]. The Anterior Longitudinal Ligament attaches to the front (anterior) of each vertebra. Its superficial fibers span several vertebrae, and its deep fibers course between adjacent vertebrae. ; Bhandari, M.; Kreder, H.; Moroni, A.; Richardson, M.; Walter, S.D. How does ossification of posterior longitudinal ligament progress in conservatively managed patients? Radiographic and clinical evidence of ossification of the posterior longitudinal ligament lesion growth and the risk factors for late neurologic deterioration: A review: Fargen, K.M. analyzed and interpreted the data; T.H., H.H., Y.M. Although OPLL may involve any portion of the PLL, by far the most common anatomic location is the cervical spine—accounting for approximately 75% of cases. When you arch back, it prevents you from going too far. Data are expressed as the mean Â± standard deviation; OP-index, ossification index of OPLL; BMI, body mass index; DISH, diffuse idiopathic skeletal hyperostosis; JOA, Japanese Orthopedic Association; CNR, canal narrowing ratio. All authors have read and agreed to the published version of the manuscript. wrote the initial draft; T.H., N.N. Of particular interest is the observation that data on load-deformation values for the anterior longitudinal ligament are similar to those data obtained from the ligamentum flavum, suggesting that the two major stabilizing ligaments are balanced in their design (Panjabi & White 1990). We enrolled 239 patients with cervical OPLL. The lumbar posterior longitudinal ligament is much thinner, both in width and thickness, than its anterior counterpart; therefore, the main opposition to flexion of the lumbar spine comes from the ligamentum flavum (Panjabi & White 1990). Ossification of the posterior longitudinal ligament (OPLL) has been widely investigated worldwide because of its high prevalence. The vasomotor fibers probably help to increase regional blood flow to promote healing after ligamentous damage (Imai et al., 1997). Roentgenographic findings of the developmental process of cervical osteophytes causing dysphagia. 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. MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Ligaments limiting nutation include the sacrospinous, sacrotuberous, anterior capsule, anterior sacroiliac ligament, anterior longitudinal ligament, interosseous ligament, and the short posterior ligaments  p62-65  p55-60 and the lower bands of the iliolumbar ligament  p545  p52  p45-46. In the thoracic and lumbar regions, it presents a series of dentations with … Yoshimura, N.; Nagata, K.; Muraki, S.; Oka, H.; Yoshida, M.; Enyo, Y.; Kagotani, R.; Hashizume, H.; Yamada, H.; Ishimoto, Y.; et al. When people in the physical exercise, it may be because of lack of adequate guidance or not master the correct way of exercise, resulting in damage to the exercise process . A posterior approach should be considered for multilevel OPLL (more than three levels) with neutral or lordotic cervical alignment. and Cox, J.B. and Hoh, D.J. The PLL receives a significant nociceptive and vasomotor innervation. Anterior longitudinal ligament is stretched or tears, as the head snaps forward and then back again causing a whiplash injury. The two longitudinal ligaments and the ligamentum flavum function to stabilize the lumbar vertebral column in flexion (posterior longitudinal ligament and ligamentum flavum) and extension (anterior longitudinal ligament). However, laminoplasty does not directly treat the PLL and thus it does not have direct decompressive effects.44 Without treating the PLL, laminoplasty can lead to residual stenosis, which is the most common cause for an early revision surgery.47 Further, laminoplasty could be associated with accelerated axial progression of ossification.44 If a laminoplasty will not provide adequate decompression, a fusion or corpectomy should be considered. However, there was no significant correlation between the CNR grade and the pain score for each item (, The cervical OP-index grade was also closely related to OPLL in the thoracic and lumbar spine (, Various studies have examined surgical techniques, [, The findings of this surveillance study confirmed an association of the cervical OP-index with the thoracic and lumbar OP-index, which was in agreement with previous retrospective studies [. acquired the funding. In this survey, the cervical OP-index grade significantly correlated with lower extremity function, social dysfunction, and locomotive function. Therefore, it is vital to pay attention to patients with a high CNR grade in order to prevent neurologic deterioration. Hypertrophy of the PLL (HPLL) is a distinct condition that is a pathologic thickening of the PLL, and HPLL may or may not be a precursor to OPLL. The most commonly affected region is the cervical spine, usually at C4-5. Rapid Progression of Ossification of the Posterior Longitudinal Ligament … Our dedicated information section provides allows you to learn more about MDPI. Wadhwani et al (2004) re-evaluated the extent and distribution of the Hoffman ligaments. The lumbar PLL is composed of two strata of fibers, superficial and deep. OPLL typically presents with none or mild symptoms at the beginig. OPLL incidence in the cervical spine, from the clivus to C7 and in other spinal regions from T1 to S1, was evaluated on mid-sagittal CT images. ; Kim, K.J. This study aimed to clarify whether ossification predisposition influences clinical symptoms including pain, restriction of activities of daily living, and quality of life in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Yoshii, T.; Sakai, K.; Hirai, T.; Yamada, T.; Inose, H.; Kato, T.; Enomoto, M.; Tomizawa, S.; Kawabata, S.; Arai, Y.; et al. That is, it is narrow over the posterior aspect of the vertebral bodies and flares laterally at each IVD, where it attaches to the posterior aspect of the anulus fibrosus. A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical ossification of the posterior longitudinal ligament. (Yukihiro Matsuyama), K.T. The four classification types of OPLL include local, segmental, continuous, and mixed. The PLL in the middle and lower thoracic and lumbar regions differs from the PLL in the cervical region in that it becomes narrow over the vertebral bodies and then widens considerably over the IVDs in the thoracic and lumbar areas. Yoshii, T.; Egawa, S.; Hirai, T.; Kaito, T.; Mori, K.; Koda, M.; Chikuda, H.; Hasegawa, T.; Imagama, S.; Yoshida, M.; et al. Park, S.; Lee, D.H.; Ahn, J.; Cho, J.H. Mori, K.; Yoshii, T.; Hirai, T.; Iwanami, A.; Takeuchi, K.; Yamada, T.; Seki, S.; Tsuji, T.; Fujiyoshi, K.; Furukawa, M.; et al. This heterotopic ossification occurs particularly in the cervical and thoracic spine, where the spinal cord lies inside the canal space, and can result in spinal disorders, even in asymptomatic cases following minor head trauma. Help us to further improve by taking part in this short 5 minute survey, Investigation of Risk Factors for Pain Chronification in Patients Suffering from Infections of the Spine, Salivary Carbohydrate-Deficient Transferrin in Alcohol- and Nicotine-Dependent Males, ossification of the posterior longitudinal ligament (OPPL), https://www.mdpi.com/2077-0383/9/12/4055/s1, http://creativecommons.org/licenses/by/4.0/. In addition, we could not determine whether the mobility of the segment affected by OPLL affects the pain and severity of myelopathy. The ligaments are seen from C7 to L5; some were segmental, others were multi-segmental, and the density of the ligaments is more than previously thought. These symptoms can come from cervical spine ligament damage. OPLL can also cause dysesthesia, an unpleasant sensation that accompanies touch. Whole-spine computed tomography images were obtained, and correlations were investigated between clinical symptoms and radiologic findings, including the distribution of OPLL, the sum of the levels where OPLL was present (OP-index), and the canal narrowing ratio (CNR) grade. Shinomiya, K.; Furuya, K.; Sato, R.; Okamoto, A.; Kurosa, Y.; Fuchioka, M. Electrophysiologic diagnosis of cervical OPLL myelopathy using evoked spinal cord potentials. Surgical treatment is a matter of controversy. The nociceptive innervation may make this ligament one of the most pain sensitive of the spine. direct or indirect surgical decompression followed by stabilization. (Yuji Matsuoka), K.W. The CNR grade was not correlated with clinical symptoms, but Grade 4 was associated with lower extremity dysfunction. Of your vertebral bodies as a musculoskeletal disorder that often leads to neurological dysfunction most vulnerable to when. 39.4, 38.4, and Y.K one of the spine is the cervical lumbar! 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