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Ossification of the Posterior Longitudinal Ligament of the Spine

OPLL


Presentation

  • The clinical and radiologic features of eight cases of OPLL are presented. These cases combined with 73 non-Japanese cases gathered from the English literature are contrasted with 2,125 Japanese cases of OPLL.[ncbi.nlm.nih.gov]
  • We present a 60-year-old Asian male with OPLL who developed progressively worsening cervical myopathy. The diagnosis and management are discussed.[ncbi.nlm.nih.gov]
  • We present here 16 non-Japanese patients in Singapore who were found to have ossification of the posterior longitudinal ligament in the cervical, thoracic and lumbar spine.[ncbi.nlm.nih.gov]
  • […] with spinal stenosis or myelopathy Associated with DISH Clinical Findings Majority of patients have no symptoms Cervical myelopathy is the most common presentation Numbness Neck pain Weakness Imaging Findings Linear ossification immediately posterior[learningradiology.com]
  • To clarify the genetic factors that predispose to OPLL, we have studied ttw (tiptoe walking), a mouse model that presents ectopic ossification of the spinal ligaments similar to OPLL and have found that the ttw phenotype is caused by the nonsense mutation[ncbi.nlm.nih.gov]
Collapse
  • Specific bony abnormalities such as bone spurs, disc space narrowing, vertebral body fracture, collapse or erosion can also be identified on plain film X-rays.[columbiaspine.org]
  • […] of non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change ICD-10-CM Codes Adjacent To M48.8X2 M48.57XG …… subsequent encounter for fracture with delayed healing M48.58 Collapsed[icd10data.com]
Fatigue
  • The cardinal symptoms such as fatigue, high fever, and swollen glands in this case were reduced by corticosteroid therapy.[ncbi.nlm.nih.gov]
  • Symptoms and treatments Some of the most common symptoms associated with anterior longitudinal ligament dysfunction include: Local pain Traveling pain Muscle weakness Numbness Soreness or stiffness Fatigue To learn more about the anterior longitudinal[laserspineinstitute.com]
Arm Pain
  • Treatment of OPLL Conservative treatment like NSAIDS, activity modification and exercises may help relieve the arm pain caused by OPLL.[emoryhealthcare.org]
  • Symptoms described in addition to neck pain (42%) and arm pain or dysesthesia (48%) include arm weakness (19%), leg weakness (15%), urinary incontinence (10%), arm and leg clumsiness or weakness, arm numbness or paresthesia, and gait difficulties each[ispub.com]
Camping
  • ., in vitro calcification, high alkaline phosphatase [ALP] activity, and elevation of cAMP levels by parathyroid hormone [PTH]).[ncbi.nlm.nih.gov]
High Fever
  • The cardinal symptoms such as fatigue, high fever, and swollen glands in this case were reduced by corticosteroid therapy.[ncbi.nlm.nih.gov]
Myopathy
  • We present a 60-year-old Asian male with OPLL who developed progressively worsening cervical myopathy. The diagnosis and management are discussed.[ncbi.nlm.nih.gov]
Suggestibility
  • However, owing to the segregation rate in the siblings exceeding 0.25 and the high prevalence of OPLL in the parents, OPLL was suggested to be a disorder possibly controlled by autosomal dominant inheritance.[ncbi.nlm.nih.gov]
  • However, there were no reports suggesting an association between CD and ossification/calcification in spine and joints. So far, there has been no case report regarding the coexistence of these diseases in the literature.[ncbi.nlm.nih.gov]
  • These results, taken together with the hypothesis that serum GHBP reflects the number of GH receptors in tissue, suggest that GH receptors are increased in patients with OPLL.[ncbi.nlm.nih.gov]
  • Thus, our study suggests that NPPS plays an important role in the etiology of human OPLL.[ncbi.nlm.nih.gov]
  • Only BMP4 reached criteria of suggestive evidence of linkage. Because this gene is a well-known factor in osteogenetic function, BMP4 should be screened in further study for the polymorphism responsible.[ncbi.nlm.nih.gov]
Fear
  • This is my fear as well. My dr. said that my surgery would take about 5-6 hours and I will be in the hospital about a week. Recuperation could take 2 months or more due to the severe case of OPLL.[healthboards.com]
Incontinence
  • The patients reported spastic tetraparesis, sensory disorders of the limbs and, in one case, sphincter incontinence. Neuroradiological examinations showed that the posterior columns of the spinal cord were more affected than the roots.[link.springer.com]
  • There wasn’t any urinary or fecal incontinency. Radiography of the cervical spine showed an osseous extending from the posterior margins of C2 to thoracic vertebral bodies.[ispub.com]
  • Case Illustrations Patient 1 A 54-year-old woman with a history of diabetes presented with progressive gait abnormality, hand dysfunction and urinary incontinence.[omicsonline.org]
Myelopathy
  • We wish to increase awareness of this important cause of myelopathy, and to determine if the clinical characteristics of OPLL are similar in non-Japanese and Japanese patients.[ncbi.nlm.nih.gov]
  • Ossification of the posterior longitudinal ligament of the spine (OPLL) is a common cause of severe myelopathy and radiculopathy in Oriental populations. It typically involves the cervical spine.[ncbi.nlm.nih.gov]
  • Canal diameter, anteroposterior compression ratio, and spondylotic myelopathy of the spine . Spine 18:1–15, 1983. Google Scholar [30] Onji Y., Akiyama H., Shimomura Y. et al. : Posterior paravertebral ossification causing cervical myelopathy.[link.springer.com]
  • Indications for operative intervention include progressive radiculopathy, myelopathy, and neurological deterioration.[scholars.northwestern.edu]
  • Abstract Ossification of the posterior longitudinal ligament of the spine (OPLL) is a common form of human myelopathy caused by a compression of the spinal cord by ectopic ossification of spinal ligaments.[ncbi.nlm.nih.gov]
Numbness of the Hand
  • Clinical History: A 57 year old male with numbness of the hands. Diagnosis: OPLL (Ossification of the posterior longitudinal ligament) MR Technique: 3.0 Tesla scanner (Siemens Verio) using an 18-channel head coil.[clinical-mri.com]
  • Mild symptoms may include mild pain, tingling, and/or numbness in the hands. OPLL can also cause dysesthesia, an unpleasant sensation that accompanies touch. Sometimes an unpleasant sensation may be present without any touch.[columbiaspine.org]
  • Mild symptoms may include; mild pain, tingling, and/or numbness in the hands. OPLL can also cause dysesthesia, an unpleasant sensation that accompanies touch [5]. Sometimes an unpleasant sensation may be present without any touch.[physio-pedia.com]
  • The leading symptoms are numb, clumsy, painful hands and compromised fine motor skills. Further findings are atrophy of the interosseous muscles, gait disturbances, ataxia, and symptoms of progressive tetraparesis. Diagnostic work-up.[mauriziopiredda.it]
Hyperreflexia
  • […] in spinal cord compression, myelopathy and hyperreflexia.[malacards.org]
  • Limited cervical spinal motion, hyperreflexia, extensor plantar response, and arm or leg weakness were found in 65% of patients in the literature.[ispub.com]
  • Her physical examination was notable for increased tone, hyperreflexia, non-sustained clonus, mild weakness of hand intrinsics and unsteady gait. Cervical MRI revealed multilevel stenosis with findings consistent with OPLL (Figure 2).[omicsonline.org]
Neurologic Manifestation
  • . : Severe cervical stenosis due to ossification of the posterior longitudinal ligament without neurological manifestations (“silent OPLL”) . Ital. J. Neurol. Sci., 10:93–96, 1989.[link.springer.com]
  • Radiological and neurological manifestations. Radiology 143:469–474, 1982 PMID: 7071349 16.[e-kjs.org]
Cervical Cord Compression
  • The symptoms are similar to those of cervical cord compression. Treatment of OPLL Conservative treatment like NSAIDS, activity modification and exercises may help relieve the arm pain caused by OPLL.[emoryhealthcare.org]

Workup

Soft Tissue Calcification
  • This enzyme regulates soft-tissue calcification and bone mineralization by producing inorganic pyrophosphate, a major inhibitor of calcification.[ncbi.nlm.nih.gov]

Treatment

  • Increased awareness of this condition, which has potentially devastating neurologic complications, will favorably influence diagnosis, treatment, and outcome.[ncbi.nlm.nih.gov]
  • Treatment of OPLL Conservative treatment like NSAIDS, activity modification and exercises may help relieve the arm pain caused by OPLL.[emoryhealthcare.org]
  • The ideal surgery for decompression remains highly debatable as various methods of surgical treatment of ossification of the posterior longitudinal ligament have been devised.[scholars.northwestern.edu]
  • Traditional Treatments Traditional treatments of OPLL depend on the severity of the disease.[livestrong.com]
  • Conservative and surgical treatment methods were described, with particular reference to spinal canal-widening operations.[ncbi.nlm.nih.gov]

Prognosis

  • […] spaces becomes less dense on all MR imaging sequences as disease progresses Differential Diagnosis Calcified herniated disc Calcified meningioma Calcified epidural hematoma Treatment Symptomatic patients may undergo decompression such as by laminectomy Prognosis[learningradiology.com]
  • : continuous (ossification of several vertebral segments) type 2 : segmental (several segments are affected, ossification is disrupted) type 3 : mixed (mix of types 1 and 2) type 4 : localised (circumscribed, only one or two segments) Treatment and prognosis[radiopaedia.org]
  • ., [5] supplemented by the Nurick myelopathy classification system. [6] Prognosis [ edit ] Most patients suffer from only mild symptoms. [1] Symptoms typically last approximately 13 months. [1] Of patients without myelopathy at initial presentation, only[en.wikipedia.org]
  • MRI evidence of spinal cord myelomalacia may facilitate assessment of the prognosis for neurological recovery with surgical intervention.[clinicalgate.com]
  • OPLL: disease entity, incidence, literature search and prognosis. In: Yoneobu K, Nakamura K, Toyama Y,, eds. OPLL: Ossification of the Posterior Longitudinal Ligament. 2nd ed. Tokyo, Japan: Springer; 2006: 11-17 12 Epstein NE.[thieme-connect.com]

Etiology

  • Thus, our study suggests that NPPS plays an important role in the etiology of human OPLL.[ncbi.nlm.nih.gov]
  • No conclusions were reached concerning etiology, but common findings included a generalized hyperostotic tendency, a tendency for abnormal glucose metabolism, and low enteral calcium absorption. A relatively high hereditary occurrence was noted.[ncbi.nlm.nih.gov]
  • OPLL is predominantly observed in males. with a prevalence ratio of 2:1, and our gender-specific associations indicate that genetic factors involving COL11A2 play a specific role in the etiology of OPLL exclusively in males.[ncbi.nlm.nih.gov]
  • Analyses of gene expression in and around the loci suggested that several genes are involved in OPLL etiology through membranous and/or endochondral ossification processes. Our results bring new insight to the etiology of OPLL.[ncbi.nlm.nih.gov]
  • Abstract Research to date has identified several genes that are implicated in the etiology of ossification of the posterior longitudinal ligament of the spine (OPLL); however, their pathogenetic relevance remains obscure.[ncbi.nlm.nih.gov]

Epidemiology

  • An epidemiologic study was conducted by this group in Japan and in eastern Asiatic countries. Symptoms and disabilities caused by the disease were described. Roentgenographic findings were classified as continuous, segmental, mixed, or localized.[ncbi.nlm.nih.gov]
  • SUMMARY OF BACKGROUND DATA: Previous epidemiologic studies conducted in Japan showed consuming vegetable protein and salt was a risk factor for OPLL. Dietary habits of the Taiwanese and Japanese people are similar.[ncbi.nlm.nih.gov]
  • Although its etiology is thought to involve a multiplicity of factors, epidemiological and family studies strongly implicate genetic susceptibility in the pathogenesis of OPLL.[ncbi.nlm.nih.gov]
  • […] posterior longitudinal ligament of the spine (OPLL). 2003) Genomewide linkage and linkage disequilibrium analyses identify COL6A1, on chromosome 21, as the locus for ossification of the posterior longitudinal ligament of the spine. and Japan Collaborative Epidemiological[medical-dictionary.thefreedictionary.com]
  • For these same photos, click here and here For more information, click on the link if you see this icon Inamasu J et al: Ossification of the posterior longitudinal ligament: an update on its biology, epidemiology, and natural history.[learningradiology.com]
Sex distribution
Age distribution

Pathophysiology

  • This observation is considered to be an important clue to understanding the pathophysiology of OPLL.[ncbi.nlm.nih.gov]
  • Spine. (2005) [ Pubmed ] Pathophysiological role of endothelin in ectopic ossification of human spinal ligaments induced by mechanical stress.[wikigenes.org]
  • Stapleton CJ, Pham MH, Attenello FJ, Hsieh PC (2011) Ossification of the posterior longitudinal ligament: genetics and pathophysiology. Neurosurg Focus 30: E6.[omicsonline.org]
  • Pathophysiologically, OPLL follows a progressive evolutionary process.[clinicalgate.com]

Prevention

  • Modifying dietary habits may help prevent this disease, especially in those high-risk populations.[ncbi.nlm.nih.gov]
  • METHODS: To facilitate early prediction and prevention of OPLL, we analyzed life styles such as sleeping habit, physical exercise, smoking, alcohol drinking and hangover in subjects in the prime of life.[ncbi.nlm.nih.gov]
  • This study may serve as a stimulus for evaluation of the use of various drugs that may improve the response to insulin in the tissues regulating glucose metabolism to prevent the progression of ossification.[ncbi.nlm.nih.gov]
  • If conservative treatment is unsuccessful, spine surgery may be recommended to relieve pressure on the spinal cord and prevent future damage and loss of neurological function.[emoryhealthcare.org]
  • CONCLUSION: The risk of developing OPLL may possibly be reduced gradually and effectively by removing or minimizing the effect of such lifestyle factors one at a time through targeted preventive intervention.[ncbi.nlm.nih.gov]

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