Cervical myelopathy: OPLL

The posterior longitudinal ligament is a flexible structure that connects and stabilizes the bones of the spinal column. It runs almost the entire length of the spine, from the 2nd vertebra in the cervical spine (neck) all the way down to the sacrum (end of the spine). The ligament is near to the spinal cord. Ossification of the posterior longitudinal ligament (OPLL) is a condition in which a flexible structure becomes thicker and less flexible.

OPLL most often occurs at the cervical spine (spine in the neck).

What are the Symptoms?

  • OPLL typically begins with no or mild symptoms. Mild symptoms may include mild pain, tingling, and/or numbness in the hands.
  • As OPLL progresses, symptoms typically become more severe. If the ligament takes up valuable space within the spinal canal as it thickens, it may compress (squeeze) the spinal cord, producing myelopathy(spinal cord compression).
  • Symptoms of myelopathy include difficulty walking( imbalance on walking) difficulty in holding objects, things falling from hands, difficulty in writing, and difficulty with Stool and urine control.
  • The majority of cases will include a slow progression of symptoms, but in some cases, symptoms may suddenly become worse after a mild injury.

What are its Causes and Risk Factors?

  • The causes of OPLL are not fully understood. Genetic, hormonal, environmental, and lifestyle factors seem to play a role.
  • OPLL is usually detected in men in their 50’s and 60’s.

How is it Diagnosed?

If a patient presents with clinical problems associated with OPLL, these test may be required :

  • X-ray (also known as plain films) – Specific bony abnormalities such as bone spurs, disc space narrowing, can  be identified on plain film X-rays.
  • Computed tomography (CT) scan – CT scans are more detailed than general X-rays.
  • Magnetic resonance (MR)  imaging – to assess spinal cord compression.

What are the treatment options?

When symptoms are mild and not progressive, OPLL can be addressed Just observation.

However, surgery may be considered if a patient develops progressive signs or symptoms of myelopathy, such as abnormal reflexes or Imbalance on walking, or if there is radiographic evidence of injury or ongoing compression of the spinal cord.

The surgeon may perform any of the following procedures:

  • Anterior cervical discectomy with fusion (ACDF)
  • Anterior cervical corpectomy with fusion
  • Posterior Laminectomy
  • Posterior Laminectomy and fusion( lateral mass fixation)
  • Combined anterior and posterior approach