Ossification (OPLL)

Ossification of the posterior ligament of the cervical spine, gradually narrowing the spinal canal and compressing the spinal cord.

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Spine Surgery (Degenerative and Deformity)

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1Overview

Quick and clear information for patients

What is this Condition?

OPLL, also known among the public as ossification of the posterior cervical ligament, is a condition in which a strong ligament passing behind the spine gradually hardens and ossifies over time. It occurs most frequently in the cervical region. As this ossification narrows the canal through which the spinal cord passes, it can cause compression of the spinal cord over time. The process progresses very slowly and patients may have no symptoms for a long time; therefore, it is often discovered incidentally on imaging obtained for another reason. When symptoms develop, they typically begin with loss of dexterity in the hands, numbness, and balance problems. It occurs more frequently in populations of Asian descent and generally in those over age 50. Conditions such as diabetes may be associated with this ossification.

Symptoms

Loss of dexterity in the hands: difficulty with buttoning, writing, and grasping small objects

Neck pain and stiffness, restricted neck movement

Unsteadiness with walking, staggering gait

Weakness in the arms and legs

Problems with bladder and bowel control in advanced cases

Diagnosis Methods

Diagnosis begins with cervical X-rays; ossification may be seen as a white shadow. Computed tomography (CT) best demonstrates the location and shape of the ossification and confirms the diagnosis. MRI is obtained to assess the degree of spinal cord compression and whether there is cord damage. These two imaging modalities together are used for both diagnosis and treatment planning.

Treatment Methods

In patients with no symptoms or mild complaints, regular follow-up and supportive measures such as medication and physical therapy are usually preferred over surgery. When spinal cord compression becomes significant and symptoms such as loss of hand dexterity, weakness, or gait disturbance progress, surgery is indicated. The procedure aims to reduce pressure on the spinal cord and may be performed from behind the neck (by widening the spinal canal) or from the front (by directly removing the ossification), depending on the case. The choice of approach is determined by the shape, location, and cervical anatomy of the ossification.

Regular MRI follow-up in asymptomatic or mild cases

Medication therapy for pain and stiffness with careful physical therapy (avoiding neck manipulation)

Posterior cervical approach with spinal canal widening (laminoplasty)

Anterior cervical approach with removal of ossification and spinal stabilization when necessary

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Servikal anterior diskektomi ve/veya foraminotomi

Servikal anterior diskektomi ve/veya foraminotomi procedure

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Servikal anterior diskektomi ve greft/kafes yerleştirilmesi

Servikal anterior diskektomi ve greft/kafes yerleştirilmesi procedure

Open treatment detail

Cervical anterior discectomy and artificial disc replacement

Removal of the herniated disc compressing the nerve in the cervical spine and replacement with a motion-preserving artificial disc

Open treatment detail

Servikal diskektomi ve/veya foraminotomi, endoskopik

Servikal diskektomi ve/veya foraminotomi, endoskopik procedure

Open treatment detail

Editorial Notes

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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Ossification (OPLL)

Spine Surgery (Degenerative and Deformity)

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Servikal anterior diskektomi ve/veya foraminotomi

Servikal anterior diskektomi ve greft/kafes yerleştirilmesi

Cervical anterior discectomy and artificial disc replacement

Servikal diskektomi ve/veya foraminotomi, endoskopik

Related Blog Posts

Current Approaches in Cervical Disc Herniation Treatment

OPLL: Laminoplasty or Decompression in Cervical Myelopathy?

When is Plate-Screw Fixation Required in Cervical Disc Herniation?

References

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Related Treatments

Servikal anterior diskektomi ve/veya foraminotomi

Servikal anterior diskektomi ve greft/kafes yerleştirilmesi

Cervical anterior discectomy and artificial disc replacement

Servikal diskektomi ve/veya foraminotomi, endoskopik

Related Blog Posts

Current Approaches in Cervical Disc Herniation Treatment

OPLL: Laminoplasty or Decompression in Cervical Myelopathy?

When is Plate-Screw Fixation Required in Cervical Disc Herniation?

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