MAY’S MONTHLY TOPIC: OPLL
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What is ossification of the posterior longitudinal ligament? Ossification of
the posterior longitudinal ligament, also known as OPLL?
A: It’s a spinal
condition where the posterior longitudinal ligament becomes calcified and less flexible.
Is OPLL a disease?
A: Yes, OPLL has an incidence of 1.9% to 4.3% in Japan and 0.01%
to 1.7% in Europe: males are twice as likely to have OPLL as
females and the average age at onset is older than 50
years. OPLL is known to have a strong genetic
predisposition and a prevalence of 29% in siblings has
been demonstrated.
What causes this condition to occur?
A: OPLL is a multifactorial condition caused by ectopic hyperostosis and calcification of the posterior longitudinal ligament. Familial inheritance and genetic factors have been implicated in the etiology of OPLL. The cervical spine is most commonly affected followed by the thoracic spine.
A: The exact cause for this condition is as of right now, unknown.
When does OPLL typically happen?
A: occurs when the soft tissues on the spine calcify and narrow the spinal canal. This causes compression of the nerves in the cervical spinal cord.
What causes the calcification of spinal ligaments?
A: Calcification of the ligamentum flavum is a process of unknown pathogenesis. A proposed
theory is that repetitive microtrauma to the ligamentum flavum initiates the calcific
deposition. This microtrauma leads to neovascularization, permeability, and hypertrophy of the ligamentum flavum.
What should people know about this condition?
A: As stated earlier while the cause of this condition is unknown, this condition does dhow that affect people of Asian descent. The following also can play a role in this condition:
Genetics
Lifestyle
Hormones factors
What are the risk factors of OPPL?
A: A multivariate logistic regression analysis revealed that age (Odds ratio (OR): 1.03), male
sex (OR: 1.91), and the presence of plaque in the carotid artery (OR: 1.71) were risk factors
for OPLL.
Is OPLL Hereditary?
A: Yes, Several clinical and environmental factors, including age, diabetes mellitus (DM), obesity,
Vitamin A-rich diet, exercise, and abnormal mechanical stress to the head have been considered risk factors for OPLL. On the other hand, OPLL is known to have a strong genetic predisposition.
What are the clinical symptoms of OPLL, (early stage)?
A: At the early stage, most OPLL patients do not have symptoms and complain of mild pain,
discomfort, or numbness in their hands. As OPLL grows, symptoms increase in severity due to
compression of the spinal cord and nerve roots.
What is myelopathy?
A: It is a significant spinal injury that can be caused by several conditions like spinal injury, trauma, or degenerative disc disease.
Does OPLL cause myelopathy?
A: Yes, Cervical ossification of the posterior longitudinal ligament (C-OPLL) is recognized as a
common clinical entity that causes complicated myelopathy of the cervical spinal cord. It is
believed that myelopathy develops due to compression of the spine by C-OPLL.
What are the options for treating OPLL?
A: OPLL can be treated via an anterior (ie, corpectomy and fusion) or posterior (ie,
laminectomy and fusion or laminoplasty) approach, or both. The optimal approach is
dictated by the classification and extent of OPLL, cervical spine sagittal alignment, severity of stenosis, and history of previous surgery.
Treatments. When symptoms are mild and not progressive, OPLL can be addressed with
nonoperative measures. Nonoperative treatments may include pain medications, anti-
inflammatory medications, anticonvulsants, non-steroidal anti-inflammatory drugs (NSAIDs), and topical opioids.
What is conservative treatment for OPLL?
A: Conservative Therapy for Cervical OPLL
Conservative therapy for cervical radicular pain and axial pain is performed using various
medications, including anti-inflammatory analgesics, muscle relaxants, vitamin B12,
neuropathic pain medications, steroids, and weak opioids.
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