Ossification of the Posterior Longitudinal Ligament
Neck stiffness and numbness in the hands and feet mean it is easily misdiagnosed as a cervical disc. If left to worsen, the spinal canal can narrow severely and surgery may be needed.
The neck has ligaments in front of and behind the vertebrae. In OPLL, the posterior ligament hardens and thickens, pressing on the nerves passing through the spinal canal and causing pain.
Common causes
01
Genetic factors
02
Ethnic factors (reported to be relatively common in East Asians, including Koreans and Japanese)
03
Trauma, diabetes or excessive bone formation
Signs to watch for
- Numbness, pain and weakness in the arms or hands; in severe cases, paralysis of the arms and legs
- Difficulty walking
- Pain or stiffness at the back of the neck
How we diagnose
X-ray
The basic first test. Further tests may be added for a definite diagnosis.
MRI
Shows soft tissue that X-ray cannot, such as muscles, ligaments, discs, cartilage, nerves and blood vessels.
How we treat it
Apart from surgery, there is no treatment that removes the cause, so early conservative treatment reduces pain and keeps symptoms from worsening.
Trigger point injection (TPI)
Injections lower inflammation to relieve pain. Effective early on for disc disease, stenosis and straight neck, where knotted muscles that support bones and joints cause pain.
Neck brace
Limiting neck movement helps damaged tissue recover. Combined with traction and physical therapy, it reduces pain and keeps symptoms from worsening until surgery, if needed.
Laminoplasty (surgery)
The lamina at the back of the vertebra is cut and reshaped to relieve pressure on the nerve, without removing or greatly changing the bone. It requires advanced surgical skill.
When surgery is consideredIf the right time for treatment is missed, even surgery may not help much, so ongoing management and careful review of surgical timing are very important.