International Orthopaedics

, Volume 42, Issue 4, pp 835–842 | Cite as

Natural history of the ossification of cervical posterior longitudinal ligament: a three dimensional analysis

  • Keiichi Katsumi
  • Kei Watanabe
  • Tomohiro Izumi
  • Toru Hirano
  • Masayuki Ohashi
  • Tatsuki Mizouchi
  • Takui Ito
  • Naoto Endo
Original Paper
First Online:
Received:
Accepted:

Abstract

Purpose

Three-dimensional (3D) imaging using computed tomography (CT) has made it possible to accurately evaluate ossification of the posterior longitudinal ligament (OPLL). Recently, we developed a novel technique to measure ossification volume using the 3D analysis. The purpose of this study was to investigate the natural course of OPLL and the risk factors for volume progression.

Methods

Forty-one patients (22 males and 19 females) diagnosed with cervical OPLL who had been non-surgically treated were included in this study. We evaluated clinical examination, radiological findings, and the volume of ossified lesions during at least 1-year intervals. Furthermore, we performed risk factor analysis for OPLL volume progression.

Results

The mean ossification volume was 2047.4 ± 1437.3 mm3 in the first examination and 2201.0 ± 1524.1 mm3 in the final examination, indicating a significant increase during the follow-up period (p < 0.001). The mean annual rate of lesion increase was 4.1 ± 2.7%. Univariate regression analysis demonstrated significant relationships between the annual rate of lesion increase and age (β = −0.48; p = 0.001), body weight (BW) (β = 0.36; p = 0.02), and body mass index (BMI) (β = 0.35; p = 0.03). Furthermore, age was the only significant predictor of OPLL progression (R2 = 0.23; p = 0.001) in multivariate liner regression analysis.

Conclusions

Younger age, higher BW, and higher BMI are predictors of OPLL progression. Younger age is the most significant predictor in non-surgically treated patients.

Keywords

Ossification Three-dimensional Volume Progression Risk factors 
This is a preview of subscription content, log in to check access

Notes

Compliance with ethical standards

Conflict of interest

None.

Supplementary material

264_2017_3667_MOESM1_ESM.xlsx (24 kb)
ESM 1 (XLSX 23 kb)

References

  1. 1.
    Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K, Yoshikawa H (2007) Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: part 1: clinical results and limitations of laminoplasty. Spine (Phila Pa 1976) 32:647–653.  https://doi.org/10.1097/01.brs.0000257560.91147.86 CrossRefGoogle Scholar
  2. 2.
    Fragen KM, Cox JB, Hoh DJ (2012) Does ossification of the posterior longitudinal ligament progress after laminoplasty? Radiographic and clinical evidence of ossification of the posterior longitudinal ligament lesion growth and the risk factors for late neurologic deterioration. J Neurosurg Spine 17:512–524.  https://doi.org/10.3171/2012.9.SPINE12548 CrossRefGoogle Scholar
  3. 3.
    Matsunaga S, Nakamura K, Seichi A et al (2008) Radiographic predictors for the development of myelopathy in patients with ossification of the posterior longitudinal ligament: a multicenter cohort study. Spine (Phila Pa 1976) 33:2648–2650.  https://doi.org/10.1097/BRS.0b013e31817f988c CrossRefGoogle Scholar
  4. 4.
    Kawaguchi Y, Kanamori M, Ishihara H, Nakamura H, Sugimori K, Tsuji H, Kimura T (2001) Progression of ossification of the posterior longitudinal ligament following en bloc cervical laminoplasty. J Bone Joint Surg Am 83:1798–1802CrossRefPubMedGoogle Scholar
  5. 5.
    Iwasaki M, Kawaguchi Y, Kimura T, Yonenobu K (2002) Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg 96:180–189PubMedGoogle Scholar
  6. 6.
    Hori T, Kawaguchi Y, Kimura T (2007) How does the ossification area of the posterior longitudinal ligament thicken following cervical laminoplasty? Spine (Phila Pa 1976) 32:E551–E556.  https://doi.org/10.1097/BRS.0b013e31814614f3 CrossRefGoogle Scholar
  7. 7.
    Matsunaga S, Sakou T, Taketomi E, Komiya S (2004) Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study. J Neurosurg 100:245–248PubMedGoogle Scholar
  8. 8.
    Takatsu T, Ishida Y, Suzuki K, Inoue H (1998) Radiological study of cervical ossification of the posterior longitudinal ligament. J Spinal Disord 12:271–273Google Scholar
  9. 9.
    Fujimori T, Iwasaki M, Nagamoto Y et al (2012) Three-dimensional measurement of growth of ossification of the posterior longitudinal ligament. J Neurosurg Spine 16:289–895.  https://doi.org/10.3171/2011.11.SPINE11502 CrossRefPubMedGoogle Scholar
  10. 10.
    Izumi T, Hirano T, Watanabe K, Sano A, Ito T, Endo N (2013) Three-dimensional evaluation of volume change in ossification of the posterior longitudinal ligament of the cervical spine using computed tomography. Eur Spine J 22:2569–2574.  https://doi.org/10.1007/s00586-013-2989-9 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Katsumi K, Izumi T, Ito T, Hirano T, Watanabe K, Ohashi M (2016) Posterior instrumented fusion suppresses the progression of ossification of the posterior longitudinal ligament: a comparison of laminoplasty with and without instrumented fusion by three dimensional analysis. Eur Spine J 25:1634–1640.  https://doi.org/10.1007/s00586-015-4328-9 CrossRefPubMedGoogle Scholar
  12. 12.
    Investigation Committee on OPLL of the Japanese Ministry of Public Health and Welfare (1981) The ossification of the posterior longitudinal ligament of the spine (OPLL). Nihon Seikeigeka Gakkai Zasshi 55:425–440Google Scholar
  13. 13.
    Japanese Orthopaedic Association (1994) Scoring system for cervical myelopathy. J Jpn Orthop Assoc 68:134–147 (in Japanese) Google Scholar
  14. 14.
    Jayakumar PN, Kolluri VR, Vasudev MK, Srikanth SG (1996) Ossification of the posterior longitudinal ligament of the cervical spine in Asian Indians: a multiracial comparison. Clin Neurol Neurosurg 98:142–148.  https://doi.org/10.1016/0303-8467(96)00004-2 CrossRefPubMedGoogle Scholar
  15. 15.
    Tokuhashi Y, Ajiro Y, Umezawa N (2009) A patient with two re-surgeries for delayed myelopathy due to progression of ossification of the posterior longitudinal ligaments after cervical laminoplasty. Spine (Phila Pa 1976) 34:E101–E105.  https://doi.org/10.1097/BRS.0b013e31818a3135 CrossRefGoogle Scholar
  16. 16.
    Chiba K, Yamamoto I, Hirabayashi H, Iwasaki M, Goto H, Yonenobu K, Toyama Y (2005) Multicenter study investigating the postoperative progression of ossification of the posterior longitudinal ligament in the cervical spine: a new computer-assisted measurement. J Neurosurg Spine 3:17–23CrossRefPubMedGoogle Scholar
  17. 17.
    Taketomi E (1997) Progression of ossification of the posterior longitudinal ligament in the cervical spine. J Spine Res 8:359–366 (in Japanese) Google Scholar
  18. 18.
    Kajiura K, Ikata T, Katoh S, Sairyo K, Chikawa T, Hamada Y (1998) The progression of ossification of the posterior longitudinal ligament: a long-term follow-up study of more than 10 years (author’s translation). Investigation committee 1998 report on the ossification of the spinal ligaments of the Japanese Ministry of Public Health and welfare. Springer, Tokyo, pp 146–148 (in Japanese) Google Scholar
  19. 19.
    Akune T, Ogata N, Seichi A, Ohnishi I, Nakamura K, Kawaguchi H (2001) Insulin secretory response is positively associated with the extent of ossification of the posterior longitudinal ligament of the spine. J Bone Joint Surg Am 83-A:1537–1544CrossRefPubMedGoogle Scholar
  20. 20.
    Shingyouchi Y, Nagahama A, Niida M (1996) Ligamentous ossification of the cervical spine in the late middle-aged Japanese men. Its relation to body mass index and glucose metabolism. Spine (Phila Pa 1976) 21:2474–2478CrossRefGoogle Scholar
  21. 21.
    Thomas DM, Hards DK, Roġers SD, Ng KW, Best JD (1997) Insulin and bone, clinical and scientific view. Endocrinol Metab North Am 4:5–17Google Scholar
  22. 22.
    Chang H, Kong CG, Won HY, Kim JH, Park JB (2010) Inter- and intra-observer variability of a cervical OPLL classification using reconstructed CT images. Clin Orthop Surg 2:8–12CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Fujimori T, Iwasaki M, Nagamoto Y et al (2012) Three-dimensional measurement of intervertebral range of motion in ossification of the posterior longitudinal ligament: are there mobile segments in the continuous type? J Neurosurg Spine 17:74–81CrossRefPubMedGoogle Scholar
  24. 24.
    Matsumoto M, Chiba K, Toyama Y (2012) Surgical treatment of ossification of the posterior longitudinal ligament and its outcomes: posterior surgery by laminoplasty. Spine (Phila Pa 1976) 37:E303–E308.  https://doi.org/10.1097/BRS.0b013e318239cca0 CrossRefGoogle Scholar
  25. 25.
    Fujiyoshi T, Yamazaki M, Kawabe J et al (2008) A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line. Spine (Phila Pa 1976) 33:E990–E993.  https://doi.org/10.1097/BRS.0b013e318188b300 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  • Keiichi Katsumi
    • 1
  • Kei Watanabe
    • 2
  • Tomohiro Izumi
    • 3
  • Toru Hirano
    • 2
  • Masayuki Ohashi
    • 2
  • Tatsuki Mizouchi
    • 2
  • Takui Ito
    • 4
  • Naoto Endo
    • 2
  1. 1.Department of Orthopedic Surgery, Uonuma Institute of Community MedicineNiigata University Medical and Dental HospitalNiigataJapan
  2. 2.Department of Orthopedic SurgeryNiigata University Medical and Dental General HospitalNiigataJapan
  3. 3.Spine Center, Department of Orthopedic SurgeryNiigata Central HospitalNiigataJapan
  4. 4.Department of Orthopedic SurgeryNiigata City General HospitalNiigataJapan

Personalised recommendations