OPLL (Ossification of Posterior Longitudinal Ligament)

Spinal ligament ossification

1Overview

Quick and clear information for patients

What is this Condition?

OPLL (Ossification of Posterior Longitudinal Ligament) is a chronic spinal disease characterized by progressive ossification of the posterior longitudinal ligament forming the anterior wall of the spinal canal. It most commonly occurs in the cervical region (C3-C6); thoracic and lumbar involvement can also occur. The ossified ligament narrows the spinal canal, causing compression of the spinal cord and nerve roots, which may lead to cervical myelopathy over time. While prevalence is 2-4% in Asian populations, it is around 0.1-1.7% in European/American populations. Genetic predisposition (COL6A1, COL11A2, NPPS), diabetes, obesity, and DISH association are important risk factors. It occurs twice as frequently in males, and diagnosis typically occurs between ages 50-60.

Symptoms

Neck pain and stiffness (most common complaint in early stage)

Numbness, tingling, and weakness in arms and hands

Walking difficulty, imbalance, spastic gait

Loss of hand dexterity (difficulty buttoning, writing difficulty)

Bladder and bowel control disturbances (advanced stage)

Cervical myelopathy signs: hyperreflexia, positive Babinski sign, Lhermitte sign

Diagnosis Methods

Diagnosis is based on imaging. Cervical CT is the gold standard in demonstrating the morphology of ossification (continuous, segmental, mixed, localized), its extent, and the degree of spinal canal narrowing. Cervical MRI evaluates the degree of spinal cord compression, the presence of myelomalacia (T2 hyperintensity), and soft tissue relationships. Plain radiographs are used for screening; dynamic (flexion-extension) radiographs demonstrate instability. K-line assessment determines laminoplasty suitability. EMG and somatosensory evoked potentials are used for objective assessment of myelopathy severity.

Treatment Methods

Treatment is individualized based on myelopathy severity, ossification type, degree of canal narrowing (>60% is a surgical indication), patient age, and comorbidities. In asymptomatic or mild cases, conservative follow-up is applied (physical therapy, neck exercises, NSAIDs, activity modification, and MRI follow-up at 6-12 month intervals). Progressive myelopathy, gait disturbance, or sphincter involvement is an indication for surgery. Surgical choice varies by region and K-line status: anterior decompression and fusion (ADF), laminoplasty (K-line positive multilevel cases), laminectomy and posterior fusion, or combined approach. Early surgery increases the chance of neurological recovery.

Anterior Cervical Decompression and Fusion (ACDF/ACCF)

Laminoplasty (open-door / French-door technique)

Laminectomy and Posterior Instrumentation

Combined Anterior and Posterior Approach

Conservative Follow-up and Physical Therapy

References

Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery. 5th ed. Elsevier; 2022:413.
Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery. 5th ed. Elsevier; 2022:415.
Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery. 5th ed. Elsevier; 2022:416.
Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:1370.
Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:1371.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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OPLL (Ossification of Posterior Longitudinal Ligament)

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

References

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