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Ossification of the Posterior Longitudinal Ligament—Clinical Management
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Ossification of the Posterior Longitudinal Ligament—Clinical Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (31 July 2023) | Viewed by 13100

Special Issue Editors

Dr. Kenichiro Sakai

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Guest Editor
Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan
Interests: OPLL; cervical alignment and balance; spinal deformity; cervical anteriror surgery; cervical total disc replacement
Dr. Toshitaka Yoshii

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Guest Editor
Department of Orthopaedics, Tokyo Medical and Dental University, Tokyo, Japan
Interests: OPLL; surgery; images; natural history; outcomes
Dr. Takeo Furuya

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Guest Editor
Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
Interests: OPLL; cervical myelopathy; spinal tumors; spinal metastasis; spinal cord injury
Dr. Masaaki Machino

E-Mail Website
Guest Editor
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Interests: OPLL; cervical myelopathy; degeneration; images; outcomes

Special Issue Information

Dear Colleagues,

Ossification of the posterior longitudinal ligament (OPLL) often leads to neurological deficits and consequently affects the quality of life and activities of daily living. Spine surgeons and neurosurgeons need to properly diagnose, interpret the pathophysiology, and formulate optimal solutions in the treatment of such patients. To date, various studies have been conducted to develop diagnostic and therapeutic approaches, but the exact causes of OPLL have yet to be elucidated. Therefore,  its natural course remains unclear, and there are many difficult cases that need therapeutic intervention.

In this Special Issue, entitled "Ossification of The Posterior Longitudinal Ligament-Clinical Management", we would like to invite original papers or review articles on recent basic research, natural history, surgical innovations, the development of new diagnostic methods, and long-term perspectives in the clinical treatment of OPLL. In addition, OPLL is known to be a part of the condition of ossification of the spinal ligament (e.g., ossification of the ligamentum flavum (OLF)), so submission of studies on these topics is also welcome. We hope that this Special Issue will serve as a catalyst for the enlightenment and development of OPLL disease treatment.

Dr. Kenichiro Sakai
Dr. Toshitaka Yoshii
Dr. Takeo Furuya
Dr. Masaaki Machino
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ossification of the posterior longitudinal ligament
  • ossification of the spinal ligament
  • ossification of the ligamentum flavum
  • surgical treatment
  • conservative treatment

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Published Papers (5 papers)

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Editorial

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5 pages, 181 KiB  
Editorial
Treatment for the Thoracic Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum
by Masaaki Machino, Kenichiro Sakai, Toshitaka Yoshii, Takeo Furuya, Sadayuki Ito, Naoki Segi, Jun Ouchida, Shiro Imagama and Hiroaki Nakashima
J. Clin. Med. 2022, 11(16), 4690; https://doi.org/10.3390/jcm11164690 - 11 Aug 2022
Cited by 7 | Viewed by 2023
Abstract
The T-OPLL natural course has not been extensively reported, and evidence to support the timing of surgery is also lacking [...] Full article
(This article belongs to the Special Issue Ossification of the Posterior Longitudinal Ligament—Clinical Management)

Research

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11 pages, 2400 KiB  
Article
Comparative Study of Anticipatory Postural Adjustments between Normal and Cervical Myelopathy Patients
by Haruki Funao, Tatsuya Igawa, Masaru Matsuzawa, Norihiro Isogai and Ken Ishii
J. Clin. Med. 2023, 12(10), 3584; https://doi.org/10.3390/jcm12103584 - 21 May 2023
Viewed by 1410
Abstract
Patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament have been considered to be prone to falls due to lower extremity dysfunction and gait instability. Anticipatory postural adjustments (APAs) are unconscious muscular activities to counterbalance perturbation. To date, there are [...] Read more.
Patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament have been considered to be prone to falls due to lower extremity dysfunction and gait instability. Anticipatory postural adjustments (APAs) are unconscious muscular activities to counterbalance perturbation. To date, there are no reports on APAs in cervical myelopathy patients, and quantification of postural control remains difficult. Thirty participants were enrolled, of which 15 were cervical myelopathy patients and 15 were normal age- and sex-matched controls. A three-dimensional motion capture system with force plates was used, and the APA phase was defined as the time between start of movement at the center of pressure and heel-off of the step leg. The APA phase (0.47 vs. 0.39 s, p < 0.05) and turning time (2.27 vs. 1.83 s, p < 0.01) were significantly longer, whereas step length tended to be shorter (305.18 vs. 361.04 mm, p = 0.06) in cervical myelopathy patients. There was a significant correlation between Japanese Orthopaedic Association lower extremity motor dysfunction scores and step length (p < 0.01). Cervical myelopathy patients are prone to falls due to longer APA phases with shorter step lengths. Analysis of the APA phase aids the visualization and quantification of postural control during initial gait in cervical myelopathy patients. Full article
(This article belongs to the Special Issue Ossification of the Posterior Longitudinal Ligament—Clinical Management)
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10 pages, 1353 KiB  
Article
Association of Inflammation, Ectopic Bone Formation, and Sacroiliac Joint Variation in Ossification of the Posterior Longitudinal Ligament
by Nguyen Tran Canh Tung, Zhongyuan He, Hiroto Makino, Taketoshi Yasuda, Shoji Seki, Kayo Suzuki, Kenta Watanabe, Hayato Futakawa, Katsuhiko Kamei and Yoshiharu Kawaguchi
J. Clin. Med. 2023, 12(1), 349; https://doi.org/10.3390/jcm12010349 - 2 Jan 2023
Cited by 2 | Viewed by 3183
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is considered a multifactorial condition characterized by ectopic new bone formation in the spinal ligament. Recently, its connections with inflammation as well as sacroiliac (SI) joint ankylosis have been discussed. Nevertheless, whether inflammation, spinal ligament ossification, [...] Read more.
Ossification of the posterior longitudinal ligament (OPLL) is considered a multifactorial condition characterized by ectopic new bone formation in the spinal ligament. Recently, its connections with inflammation as well as sacroiliac (SI) joint ankylosis have been discussed. Nevertheless, whether inflammation, spinal ligament ossification, and SI joint changes are linked in OPLL has never been investigated. In this study, whole-spinal computed tomography and serum high-sensitive C-reactive protein (hs-CRP) levels were obtained in 162 patients with cervical OPLL. Ossification lesions were categorized as plateau and hill shapes. Accordingly, patients were divided into plateau-shaped (51 males and 33 females; mean age: 67.7 years) and hill-shaped (50 males and 28 females; mean age: 67.2 years) groups. SI joint changes were classified into four types and three subtypes, as previously described. Interactions among ossification shapes, hs-CRP levels, and morphological changes in the SI joint were investigated. The plateau shape was more common in the vertebral segments (59.5%), compared to the hill shape, which was predominant in the intervertebral regions (65.4%). Serum hs-CRP levels in the plateau-shaped group (0.11 ± 0.10 mg/dL) were significantly higher than those in the hill-shaped group (0.07 ± 0.08 mg/dL). SI joint intra-articular fusion was the main finding in the plateau-shaped group and showed significantly higher hs-CRP levels compared to the anterior para-articular bridging, which more frequently occurred in the hill-shaped group. Our findings suggested a possible inflammation mechanism that might contribute to the new bone formation in OPLL, particularly the plateau shape. Full article
(This article belongs to the Special Issue Ossification of the Posterior Longitudinal Ligament—Clinical Management)
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12 pages, 1253 KiB  
Article
Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study)
by Takashi Hirai, Toshitaka Yoshii, Jun Hashimoto, Shuta Ushio, Kanji Mori, Satoshi Maki, Keiichi Katsumi, Narihito Nagoshi, Kazuhiro Takeuchi, Takeo Furuya, Kei Watanabe, Norihiro Nishida, Soraya Nishimura, Kota Watanabe, Takashi Kaito, Satoshi Kato, Katsuya Nagashima, Masao Koda, Hiroaki Nakashima, Shiro Imagama, Kazuma Murata, Yuji Matsuoka, Kanichiro Wada, Atsushi Kimura, Tetsuro Ohba, Hiroyuki Katoh, Masahiko Watanabe, Yukihiro Matsuyama, Hiroshi Ozawa, Hirotaka Haro, Katsushi Takeshita, Morio Matsumoto, Masaya Nakamura, Satoru Egawa, Yu Matsukura, Hiroyuki Inose, Atsushi Okawa, Masashi Yamazaki and Yoshiharu Kawaguchiadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(13), 3694; https://doi.org/10.3390/jcm11133694 - 27 Jun 2022
Cited by 3 | Viewed by 2299
Abstract
Background: The purpose of this study was to clarify the clinical features of ossification of the posterior longitudinal ligament (OPLL) and extreme ossification at multiple sites. Methods: This prospective study involved patients with a diagnosis of cervical OPLL at 16 institutions in Japan. [...] Read more.
Background: The purpose of this study was to clarify the clinical features of ossification of the posterior longitudinal ligament (OPLL) and extreme ossification at multiple sites. Methods: This prospective study involved patients with a diagnosis of cervical OPLL at 16 institutions in Japan. Patient-reported outcome measures, including responses on the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ), JOA Back Pain Evaluation Questionnaire (JOA-BPEQ), and visual analog scale pain score, were collected to investigate clinical status. In each patient, the sum of the levels at which OPLL was located (OP index) was evaluated on whole-spine computed tomography, along with ossification of other spinal ligaments including the anterior longitudinal ligament (OALL), ligament flavum (OLF), supra- and intraspinous ligaments (SSL), and diffuse idiopathic skeletal hyperostosis (DISH). The distribution of OP index values in the study population was investigated, and the clinical and radiologic characteristics of patients in the top 10% were assessed. Results: In total, 236 patients (163 male, 73 female; mean age 63.5 years) were enrolled. Twenty-five patients with OP index ≥ 17 were categorized into a high OP index group and the remainder into a moderate/low OP index group. There were significantly more women in the high OP index group. Patients in the high OP index group also had significantly poorer scores for lower extremity function and quality of life on the JOA-CMEQ and in each domain but not for body pain on the JOA-BPEQ compared with those in the moderate/low OP index group. Patients in the high OP index group had more OALL in the cervical spine and more OLF and SSL in the thoracic spine. The prevalence of DISH was also significantly higher in the high OP index group. In the high OP index group, interestingly, OPLL was likely to be present adjacent to DISH in the cervicothoracic and thoracolumbar spine, especially in men, and often coexisted with DISH in the thoracic spine in women. Conclusion: This prospective cohort registry study is the first to demonstrate the clinical and radiologic features of patients with OPLL and a high OP index. In this study, patients with a high OP index had poorer physical function in the lumbar spine and lower extremities and were also predisposed to extreme ossification of spinal ligaments other than the OPLL. Full article
(This article belongs to the Special Issue Ossification of the Posterior Longitudinal Ligament—Clinical Management)
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Review

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15 pages, 600 KiB  
Review
Review of Basic Research about Ossification of the Spinal Ligaments Focusing on Animal Models
by Masato Ikuta, Takashi Kaito, Takahito Fujimori, Takayuki Kitahara, Takuya Furuichi, Masayuki Bun, Hiromasa Hirai, Yuichiro Ukon, Yuya Kanie, Shota Takenaka and Seiji Okada
J. Clin. Med. 2023, 12(5), 1958; https://doi.org/10.3390/jcm12051958 - 1 Mar 2023
Cited by 1 | Viewed by 2281
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a heterotopic ossification that may cause spinal cord compression. With the recent development of computed tomography (CT) imaging, it is known that patients with OPLL often have complications related to ossification of other spinal ligaments, [...] Read more.
Ossification of the posterior longitudinal ligament (OPLL) is a heterotopic ossification that may cause spinal cord compression. With the recent development of computed tomography (CT) imaging, it is known that patients with OPLL often have complications related to ossification of other spinal ligaments, and OPLL is now considered part of ossification of the spinal ligaments (OSL). OSL is known to be a multifactorial disease with associated genetic and environmental factors, but its pathophysiology has not been clearly elucidated. To elucidate the pathophysiology of OSL and develop novel therapeutic strategies, clinically relevant and validated animal models are needed. In this review, we focus on animal models that have been reported to date and discuss their pathophysiology and clinical relevance. The purpose of this review is to summarize the usefulness and problems of existing animal models and to help further the development of basic research on OSL. Full article
(This article belongs to the Special Issue Ossification of the Posterior Longitudinal Ligament—Clinical Management)
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