Evaluation of the Ossification of the Cervical Posterior Longitudinal Ligament Utilizing X-Ray, CT and MR Imaging

Crossmark: check for updates

Authors

  • Yuko Kobashi Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugao, Ichikawa, Chiba 271-8513, Japan
  • Yohei Munetomo Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugao, Ichikawa, Chiba 271-8513, Japan
  • Akira Baba Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugao, Ichikawa, Chiba 271-8513, Japan
  • Shinji Yamazoe Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugao, Ichikawa, Chiba 271-8513, Japan
  • Takuji Mogami Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugao, Ichikawa, Chiba 271-8513, Japan

DOI:

https://doi.org/10.17140/ORTOJ-2-109

Keywords:

Ossification of Posterior Longitudinal Ligament (OPLL), MRI, Cervical spine, Posterior longitudinal ligament, Facet hypertrophy, Lateral recess stenosis

Abstract

Background: Cervical ossification of posterior longitudinal ligament (OPLL) is a common disease among the elderly population of East Asian countries. Cervical OPLL is often misdiagnosed in lateral radiography or magnetic resonance imaging (MRI). The present study analyzes the diagnostic accuracy of cervical OPLL in lateral radiography and MRI compared to computed tomography (CT).
Methods and Materials: A total of 60 Japanese patients who were clinically diagnosed with cervical OPLL by CT imagining were considered in this study. Firstly, a lateral radiograph was checked identifying a high-density structure along the posterior aspect of vertebral bodies as OPLL. Secondly, a T2 weighted MRI sagittal image was obtained which delineated a thick low-signal posterior longitudinal ligament as OPLL. Thirdly, a cervical CT investigated vertebral bodies in which OPLL was present. Subsequently, lateral radiographs and MRIs were compared to the CT scans. The diagnostic accuracy in lateral radiograph and MRI were evaluated and causes of misdiagnosis were postulated.
Results: Diagnostic accuracy utilizing lateral radiograph and MRI were 20% (12/60) and 25% (15/60), respectively. Only 5 out of the 60 cases displayed evidence of OPLL in all three modalities. Regarding each vertebral level, accuracy using lateral radiograph and MRI of each C2-C7 was C2 (88.8% and 100%), C3 (88.8% and 100%), C4 (79.5% and 97.9%), C5 (95.5% and 110.6%), C6 (42.5% and 70.2%) and C7 (23.8% and 66.6%).
Conclusions: Diagnosing cervical OPLL using lateral radiograph is prone to underestimation; whereas, diagnosis via MRI is prone to overestimation. If severe spondylosis, facet joints, and pedicle shadows occur, they can hinder the detection of OPLL in the lateral radiograph. Regarding the MRI-based diagnosis, it would be difficult to distinguish ossifications from ligament hypertrophy. However, the use of X-ray and MRI present an accurate diagnostic tool for cervical OPLL at the levels of C2, C3, C4 and C5.

References

Tsuyama N. Ossification of the posterior longitudinal liga-ment of the spine. Clin Orthop Relat Res. 1984; 184: 71-84.

Wang MY, Thambuswamy M. Ossification of the posterior longitudinal ligament in non-Asians: Demographic, clinical, and radiographic findings in 43 patients. Neurosurg Focus. 2011; 30(3): E4. doi: 10.3171/2010.12.FOCUS10277

Tuskimoto H. An autopsy case with spinal cord compression syndrome owing to ossification within spinal canal of cervical spine (in Japanese). J Jap Orthop Assoc. 196; 34: 107.

Terashima K, Maruyama S, Miyashita R. Ossification of the posterior longitudinal ligament of the cervical spine [In Japa-nese]. Orthop Surg. 1964; 15: 1081-1095

Kang MS, Lee JW, Zhang HY, Cho YE, Park YM. Diag-nosis of Cervical OPLL in Lateral Radiograph and MRI: Is it Reliable? Korean J Spine. 2012; 9(3): 205-208. doi: 10.14245/ kjs.2012.9.3.205

Ross JS. Diagnostic Imaging Spine. Salt Lake City, UT, USA: Amirsys; 2004: II276–II288.

Okada E, Matsumoto M, Fujiwara H, Toyama Y. Disc degen-eration of cervical spine on MRI in patients with lumbar disc herniation: Comparison study with asymptomatic volunteers. Eur Spine J. 2011; 20(4): 585-591. doi: 10.1007/s00586-010- 1644-y

Yang HS, Chen DY, Lu XH, et al. Choice of surgical approach for ossification of the posterior longitudinal ligament in combi-nation with cervical disc hernia. Eur Spine J. 2010; 19(3): 494- 501.

Hori T, Kawaguchi Y, Kimura T. How does the occification area of the posterior longitudinal ligament thicken following cervical laminoplasty? Spine (Phila Pa 1976). 2007; 32(19): E551-E556. doi: 10.1097/BRS.0b013e31814614f3

Downloads

Published

2017-02-27

How to Cite

Yuko Kobashi, Yohei Munetomo, Akira Baba, Shinji Yamazoe, & Takuji Mogami. (2017). Evaluation of the Ossification of the Cervical Posterior Longitudinal Ligament Utilizing X-Ray, CT and MR Imaging. Orthopedics Research and Traumatology , 35–39. https://doi.org/10.17140/ORTOJ-2-109

Issue

Volume 2 Issue 1 2017

Section

Articles

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

All content published in Orthopedics Research and Traumatology (ORT) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.