14 August, 2017
What Is OPLL in Degenerative Changes of the Spine?
OPLL, or Ossified Posterior Longitudinal Ligament, describes a general disease where the spine is compressed due to ossifications of the ligaments that run parallel to the cervical spine. These ossifications can take the shape of bone spurs or a general thickening of the ligament that gradually gets worse over time. Compression of the spine leads to a number of symptoms that drive patients to seek medication evaluation.
The "Medical Journal of the Armed Forces in India" reports that clinical identification of this disease typically only occurs after symptoms have progressed to a chronic pain stage. Detailed X-rays and Magnetic Resonance Imaging, or MRI, must be conducted in order to rule out other common spinal injuries such as disc protrusions. Measuring the spinal canal helps diagnose OPLL in most patients. A canal diameter of less than 10 mm is considered a severe form of cervical stenosis, while a diameter between 10 and 13 mm is considered a mild form of stenosis. Disc protrusions may often accompany this stenosis, which makes absolute diagnosis of OPLL difficult.
Symptoms vary from patient to patient; however, the most common symptoms, reported in "Neurosurgery Focus," are chronic neck pain and a sense of numbness or tingling in two or more of the extremities. Without surgical correction, the symptoms will often progress to partial or complete paralysis and loss of bodily function control. Although OPLL can reveal itself after acute trauma, the onset of symptoms is often gradual and usually begins in the mid to late 40s.
"Neurosurgery Focus" reports that 25 percent of patients in North America that have spinal cord injuries also develop OPLL. The majority of those with OPLL exhibit thickening and closing of the spinal canal in-between cervical vertebra two through four. Only 30 percent of OPLL patients have spinal cord compression injuries in the lumbar or thoracic regions.
Traditional treatments of OPLL depend on the severity of the disease. The primary treatment options require removal of entire vertebral discs, fusion of discs and insertions of metal plates to prevent compression of the remaining discs. All of these treatments require extended hospital stays and are very high risk. The patient loses a significant range of motion, and a second surgery will usually not be considered possible even if more problems develop.
Cutting Edge Treatments
Dr. Jho from the Jho Institute for Minimally Invasive Neurosurgery pioneered a novel technique for treating this condition. The Jho procedure enlarges the spinal cord canal through a less invasive procedure that removes only bone that is projecting into the spinal canal. Recovery time is much quicker, and the patient’s range of motion remains intact after diagnostic testing has completed. Since this surgery requires only a single overnight visit, the probability of return to fix more bone spurs that have developed or to correct other locations of bone spurs is not as daunting or risky.
- “MJAFI”; Ossification of Posterior Longitudinal Ligament; B.H. Singh, et al.; 2004.
- “Neurosurgery Focus”; Ossification of the Cervical Posterior Longitudinal Ligament: a review; N. Epstein; 2002.
- Jho Institute for Minimally Invasive Neurosurgery: Dr. Jho's Spinal Cord Decompression via Anterior Foraminotomy for Spondylotic Cervical Stenosis or OPPL
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