Posterior Surgery

Decompression is achieved by shifting the spinal cord during posterior surgery, such as with cervical laminec-tomy or laminoplasty. Expansive cervical laminoplasty has become the standard procedure for patients with myelopathy attributable to multilevel spinal stenosis caused by OPLL or cervical spondylosis. Cervical lami-nectomy was carried out until the early 1980s. The Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan...

Insulin and OPLL

Patients with OPLL and diffuse idiopathic skeletal hyperostosis (DISH) have been reported to be obese and have glucose intolerance as well 2-5 . The prevalence of OPLL is high in patients with non-insulin-dependent diabetes mellitus (NIDDM) 3,5 . Because patients with obesity and NIDDM often exhibit impaired action and increased secretion of insulin, there is a possibility that changes in the secretion or action of insulin may play a role in the progression of the disease. Our recent...

Imaging Diagnosis of Thoracic OPLL and OLF

Although ossification of the posterior longitudinal ligament (OPLL) is often detected on cervical radiographs, OPLL can also develop in the thoracic spine. It is important to note that the incidence of ossification of the ligamentum flavum (OLF) of the thoracic spine is high. Because ossification of the spinal ligaments is a disease involving systemic ossification of the ligaments, it often occurs in multiple locations simultaneously. The symptoms associated with compressive spinal cord lesions...

Concept of Doubledoor Laminoplasty

Until the 1970s, laminectomy had been the sole therapeutic option for posterior decompression of the spinal cord. However, wide laminectomy of the cervical spine sometimes caused early or late neurological deterioration (or both). The possible causes of such deterioration were the progression of malalignment such as kyphosis or listhesis, postoperative progression of ossification of the posterior longitudinal ligament (OPLL) associated with malalignment and instability of the cervical spine in...

Toshihiko Taguchi

Ossification of the posterior longitudinal ligament (OPLL) in an autopsy case was first described by Tsukimoto 1 in 1960. Since then a number of clinical and pathological studies of this disease have been reported 2-6 . Increased recognition of OPLL led the Ministry of Public Health and Welfare of Japan to appoint, in 1974, a special study group, the Investigation Committee on OPLL, to make extensive studies ranging from basic research to clinical investigation. To date, various systemic and...

Expansive Laminoplasty

Plasty Longacre

Ossification of the posterior longitudinal ligament (OPLL), considered to be one of the clinical manifestations of a generalized disease, diffuse idiopathic skeletal hyperostosis (DISH), appears as an abnormal radiopacity along the posterior margins of the vertebral bodies on lateral-view radiographs 1 . Most patients with OPLL have only mild, subjective complaints such as neck pain and numbness in their hands. However, some patients develop myelopathy, including gait disturbance and clumsiness...

Other Pathological Findings in OPLL

Hypertrophy of the Posterior Longitudinal Ligament and Ossification of the Dura Mater As a cause of compression myelopathy, hypertrophy of the posterior longitudinal ligament (PLL) is also important. Hypertrophy of the PLL is more rare than OPLL, and there is a controversy about its nature and pathology as to whether this is the early stage of OPLL. Hypertrophy of the PLL was mainly composed of chondroid tissue without formation of a remarkable ossified mass as in OPLL 21 (Fig. 10). In OPLL,...

Calciotropic Hormones and OPLL

In 1977, Adams and Davis reported an OPLL patient with idiopathic hypoparathyroidism and they found four additional cases with such an association in the literature 7 . However, no further efforts have been Fig. 1. Correlation between OPLL extent and diabetes-related insulin level to that of glucose) in OPLL patients (n 52). factors fasting plasma glucose (FPG) level, hemoglobin A1c OPLL was positively correlated with parameters of insulin (HbAlc) level, fasting serum insulin level (Fasting...

Overview of Treatment for Ossification of the Longitudinal Ligament and the Ligamentum Flavum

Opll Operation

The Investigation Committee on Ossification of the Spinal Ligaments, subsidized by the Japanese Ministry of Health, Labor, and Welfare, has conducted various studies of the ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) since 1975. In 2002, the Committee established a subcommittee on clinical practice guidelines, which set out to systematically review articles on OPLL. This review, presented in this chapter, is based on knowledge...