Ossification of Posterior Longitudinal Ligament

Ossification of posterior longitudinal ligament (OPLL) is a condition affecting the cervical spine. OPLL may lead to compression of the spinal cord and may cause symptoms of cervical myelopathy. Patients with cervical myelopathy present with symptoms of weakness and clumsiness in the hands and difficulty walking.

Anatomy of Cervical Spine

The ligaments in the spine function to provide structural support to the vertebral column. The ligaments also keep a check to prevent excessive motion in the range of movement. The spinal cord lies inside the central vertebral canal formed in the front but the vertebral body and the lamina at the back.

The posterior longitudinal ligament is present in the vertebral body’s back (front of the spinal cord). The ligament flavus is present in the back of the spinal cord.

MRI of the cervical spine showing the various ligaments surrounding the spinal cord.

MRI of the cervical spine showing the various ligaments surrounding the spinal cord.

Ossification of Posterior Longitudinal Ligament Causes & Pathology

Ossification means the formation of bone tissue in any tissue. The posterior longitudinal ligament is a flexible ligament which is naturally not ossified. The ossification in OPLL causes the ligament to become rigid and grow in size. The increased size may decrease the precarious space in the vertebral canal already occupied by the spinal cord and its coverings.

The enlargement of the ligament occurs most commonly in the cervical spine and may compress the spinal cord. The compression of the spinal cord may cause symptoms of cervical myelopathy. The ossification of posterior longitudinal ligament occurs most frequently in patients of Asian ancestry, particularly Japanese.

The exact cause of ossification of posterior longitudinal ligament has been unclear but has been thought to be caused by various factors. Diabetes, mechanical factors, a diet rich in salt, high body weight, and genetics have been associated with the ossification of the posterior longitudinal ligament.

Ossification of Posterior Longitudinal Ligament Symptoms

The symptoms of OPLL may be mild at first as the disease has a slow progression but may be accelerated in some cases. The patients may complain of pain and stiffness in the neck. There may be symptoms of altered sensation in the arms and hands. Patients may complain of feeling numbness and tingling in the upper extremities.

As the disease progresses and the compression of the cord increases, the patients may complain of clumsiness in their hands. They may experience difficulty in holding and manipulating objects. There may be difficulty walking and navigating stairs. The patients may complain of weakness in the lower extremities. In rare cases, there may be loss of bowel and bladder control.

Diagnosis

The physician extracts a thorough history and establishes a timeline of the symptoms. The physician conducts a thorough physical examination. The physical examination includes tests to look for the patient’s walking pattern, the strength in the arms and the legs, and the sensation in all four limbs.

The radiological examination includes an X-ray, CT scan and an MRI. The X-ray is usually the first imaging done in suspected OPLL. The physician is able to see the bone structure as well as ossification of the posterior longitudinal ligament.

A CT scan provides a more detailed image of the bone structures as compared to an X-ray. The MRI scan is able to discern the soft tissue structures including the spinal cord. MRI myelography may be done in patients who are unable to have a regular MRI.

Management

Nonoperative management is done in patients with mild disease. The patients are regularly followed up for observation. The conservative modalities include medications such as nonsteroidal anti-inflammatory medications and physical therapy to improve strength and flexibility.

Surgical management forms the mainstream treatment for patients with functional degradation. The surgical management is done in the form of decompression and stabilization. Different approaches may be used depending upon the patient’s anatomy and the disease process.

The decompression part of the surgery involves removing all the bony/soft tissue structures compressing the spinal cord. The segment of spine is then fused together to eliminate any motion in between the involved vertebrae. The elimination of motion provides stability and prevents any further compression.

The surgeon may access to decompress and fuse the spine either from the front, known as anterior cervical decompression and fusion. Or the surgeon may approach from behind the neck, known as posterior cervical decompression and fusion. In some cases, both anterior and posterior approaches may be used to relieve compression.

Majority of the patients experience significant relief from their symptoms after the surgery. There may be some loss of movement in the range of motion of the neck owing to the fusion.

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15:02 02 Mar 23
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21:23 25 Feb 23
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20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
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16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
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21:28 23 May 22
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23:31 19 May 22
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17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
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19:54 16 May 22
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00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
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23:17 12 May 22
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Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
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01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
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21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
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18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
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04:44 17 Nov 20
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Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
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T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
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15:03 08 Feb 20
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21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.