• Journal of Korean Neurosurgical Society
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• v.64 no.1
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• pp.69-77
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• 2021

Objective : Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features associated with the shape of the ossification, including the concept of spondylosis seems necessary because of the similarity in age distribution. Methods : Patients diagnosed with OPLL who presented with increase signal intensity (ISI) on magnetic resonance imaging were surgically treated in our department. The patients were divided into two groups (pure versus degenerative) according to the presence of disc degeneration. Results : Of 141 patients enrolled in this study, more than half (61%) were classified into the degenerative group. The pure group showed a profound male predominance, early presentation of myelopathy, and a different predilection for ISI compared to the degenerative group. The mean canal compromise ratio (CC) of the ISI was 47% in the degenerative group versus 61% in the pure group (p<0.0000). On the contrary, the global and segment motions were significantly larger in the degenerative group (p<0.0000 and p=0.003, respectively). The canal diameters and global angles did not differ between groups. Conclusion : Classifying cervical OPLL based on the presence of combined disc degeneration is beneficial for understanding the disorder's behavior. CC appears to be the main factor in the development of myelopathy in the pure group, whereas additional dynamic factors appear to affect its development in the degenerative group.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.597-603
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• 2017

Objective : Several surgical methods have been reported for treatment of ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Despite rapid innovation of instruments and techniques for spinal surgery, the postoperative outcomes are not always favorable. This article reports a minimally invasive anterior decompression technique without instrumented fusion, which was modified from the conventional procedure. The authors present 2 cases of huge beak-type OPLL. Patients underwent minimally invasive anterior decompression without fusion. This method created a space on the ventral side of the OPLL without violating global thoracic spinal stability. Via this space, the OPLL and anterior lateral side of the dural sac can be seen and manipulated directly. Then, total removal of the OPLL was accomplished. No orthosis was needed. In this article, we share our key technique and concepts for treatment of huge thoracic OPLL. Methods : Case 1. 51-year-old female was referred to our hospital with right lower limb radiating pain and paresis. Thoracic OPLL at T6-7 had been identified at our hospital, and conservative treatment had been tried without success. Case 2. This 54-year-old female with a 6-month history of progressive gait disturbance and bilateral lower extremity radiating pain (right>left) was admitted to our institute. She also had hypoesthesia in both lower legs. Her symptoms had been gradually progressing. Computed tomography scans showed massive OPLL at the T9-10 level. Magnetic resonance imaging of the thoracolumbar spine demonstrated ventral bony masses with severe anterior compression of the spinal cord at the same level. Results : We used this surgical method in 2 patients with a huge beaked-type OPLL in the thoracic level. Complete removal of the OPLL via anterior decompression without instrumented fusion was accomplished. The 1st case had no intraoperative or postoperative complications, and the 2nd case had 1 intraoperative complication (dural tear) and no postoperative complications. There were no residual symptoms of the lower extremities. Conclusion : This surgical technique allows the surgeon to safely and effectively perform minimally invasive anterior decompression without instrumented fusion via a transthoracic approach for thoracic OPLL. It can be applied at the mid and lower level of the thoracic spine and could become a standard procedure for treatment of huge beak-type thoracic OPLL.

• Journal of Korean Neurosurgical Society
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• v.46 no.2
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• pp.168-171
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• 2009

Intradural lumbar disc herniation (ILDH) is rare. In this report, authors present 2 cases of ILDHs associated with severe adhesion between the dural sac and posterior longitudinal ligament. In a 40-year-old man, ILDH occurred in association with epidural adhesion due to ossification of the posterior longitudinal ligament (OPLL). In other 31-year-old man, ILDH occurred in presence of epidural adhesion due to previous spine surgery.

• Journal of Korean Neurosurgical Society
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• v.29 no.7
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• pp.904-909
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• 2000

Objectives : Most cases of cervical ossification of the posterior longitudinal ligament(OPLL) present with myelopathy or myeloradiculopathy, which sometimes is further complicated by minor trauma to the spinal cord. The main purpose of surgery in these patients is the alleviation symptoms but also as protection against further deterioration. The purpose of this study is to analyze the influence of trauma on the surgical outcome in patients with cervical OPLL. Methods : Over the past 13 years, we have operated on 123 patients with myelopathy associated with cevical OPLL. Among these, thirty patients had cervical cord injury associated with major or minor trauma and their clinical and radiographic data were reviewed retrosepctively. Results : As to cause of trauma, seventeen were related with traffic accident and 13 were related with minor slipping injury. The pre- and post-operative motor power were significantly weaker in the patients with trauma, but the degree of motor improvement was significantly higher(trauma group : $0.90{\pm}1.49$, non-trauma group : $0.41{\pm}0.80$). Conclusion : These results indicate that even indirect minor trauma to the cervical spine can cause irreversible changes to the spinal cord if this is associated with underlying cervical stenosis with OPLL. Although less favorable results may be anticipated in patients with trauma, operative decompression could improve motor power and protect further deterioration.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.15 no.1
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• pp.135-145
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• 2020

Objectives : This study reports the clinical case of a patient diagnosed with ossification of the posterior longitudinal ligament treated with Korean Medicine focusing on Chuna therapy. Methods : The patient was treated by a doctor from July 18th, 2019 to November 28th, 2019. The patient was diagnosed with ossification of the posterior longitudinal ligament based on magnetic resonance imaging results and was recommended to undergo surgery at another hospital. The primary complaint of the patient was left neck pain, left arm sensation, right leg sensation, and right leg loss of strength. The doctor treated the patient with Chuna therapy, acupuncture, cupping, herbal medicine, and pharmacopuncture. The effect of treatment was evaluated using visual analogue scale, neck disability index, pain rating score and Japanese Orthopedic Association score. Spurling, compression, and distraction tests were utilized. Results : Visual analogue scale decreased from 10 at the arm and 10 at the leg to 1 and 2, respectively. Neck disability index decreased from 25 to 11, pain rating score decreased from 66 to 1, and Japanese Orthopedic Association score recovered from 12 to 17 points. In addition, positive spurling test, compression test, and distraction test all improved to negative. Conclusions : Korean medicine treatment can be effective for ossification of the posterior longitudinal ligament patients, even when surgery is recommended. Further clinical studies, such as case series and case-control studies, are required to verify these findings.

• Journal of Haehwa Medicine
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• v.16 no.1
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• pp.147-156
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• 2007

This study was performed to investigate the cause, symptom, treatment of OPLL through Western medicine and Dong-Eui-Bo-Kham(東醫寶鑑) Results & conclusins 1. Ossification of the posterior hgament(OPLL) have radiculopathy, myelopathy or both of them such as neck pain, numbness, myatonia 2. Neck pain of OPLL seems to be simular with pain in the neck(頸項痛), neck stiffness(項强), stiffness and pain of head and neck(頭項彈痛). The causes were usually Dampness and Cold, Wind. The treatments were classified according to pathoigenic factor(病因) and muscle along the regular meridian(經筋) 3. Radiculopathy of OPLL seems to be similar with numbness(痺證). The causes were usually, pathogenic Wind, Cold, Dampness. The treatments were classified according to diagnosis of three kinds of BI syndrome(三痺), five kind of Bi synrome(五痺), five jang Bi(五臟痺), six Bu Bi(六腑痺) 4. Myelopathy of OPLL seems to be simular with myatonia(痿證) The cause of myatoma was Lung scorched by Heat(肺熱葉無). And the treatment was purping the south and reinforcing the north(寫南方 補北方). We considered that more study to find various and effective methods oriental medicine for OPLL should be made.

• The Journal of Korea CHUNA Manual Medicine
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• v.6 no.1
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• pp.157-167
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• 2005

Objective : There is hardly case report in oriental Medicine about the ossification of the posterior longitudinal ligament(OPLL). We experienced a patient(64-year-old male) with OPLL improved by oriental Medicine treatment, and we report it clinically. Methods : While the patient with OPLL was treated acupuncture, physical therapy, and CHUNA manual therapy, we evaluated the patient's symptoms and function by visual analogue scale(VAS), clinical criteria for evaluation of the cervical myelopathy by the japanese orthopaedic association(JOA Score) and cervical spine's range of motion(ROM) in three limes for the 17 days that were a hospitalization period. Results : VAS, JOA score and ROM in OPLL patient were improved. VAS in symptoms became lower from 10 to 5. JOA score increased from 12 points to 13 points. As for the ROM, it was improved in 30.1%. Conclusion : Oriental medicine treatment may be effective in conservative treatment of OPLL. We propose that more clinical studies and reaches are accomplished in oriental medicine.

• Journal of Korean Neurosurgical Society
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• v.60 no.4
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• pp.441-447
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• 2017

Objective : Computed tomography (CT)-based method of three dimensional (3D) analysis ($MIMICS^{(R)}$, Materialise, Leuven, Belgium) is reported as very useful software for evaluation of OPLL, but its reliability and reproducibility are obscure. This study was conducted to evaluate the accuracy of $MIMICS^{(R)}$ system, and inter- and intra-observer reliability in the measurement of OPLL. Methods : Three neurosurgeons independently analyzed the randomly selected 10 OPLL cases with medical image processing software ($MIMICS^{(R)}$) which create 3D model with Digital Imaging and Communication in Medicine (DICOM) data from CT images after brief explanation was given to examiners before the image construction steps. To assess the reliability of inter- and intra-examiner intraclass correlation coefficient (ICC), 3 examiners measured 4 parameters (volume, length, width, and length) in 10 cases 2 times with 1-week interval. Results : The inter-examiner ICCs among 3 examiners were 0.996 (95% confidence interval [CI], 0.987-0.999) for volume measurement, 0.973 (95% CI, 0.907-0.978) for thickness, 0.969 (95% CI, 0.895-0.993) for width, and 0.995 (95% CI, 0.983-0.999) for length. The intra-examiner ICCs were 0.994 (range, 0.991-0.996) for volume, 0.996 (range, 0.944-0.998) for length, 0.930 (range, 0.873-0.947) for width, and 0.987 (range, 0.985-0.995) for length. Conclusion : The medical image processing software ($MIMICS^{(R)}$) provided detailed quantification OPLL volume with minimal error of inter- and intra-observer reliability in the measurement of OPLL.

• Journal of Korean Neurosurgical Society
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• v.63 no.1
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• pp.89-98
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• 2020

Objective : Ossification of posterior longitudinal ligament (OPLL) in the thoracic spine may cause chronic compressive myelopathy that is usually progressive, and unfavorable by conservative treatment. Although surgical intervention is often needed, the standard surgical method has not been established. Recently, it has been reported that posterior decompression with dekyphosis is effective surgical technique for favorable clinical outcome. The purpose of this study was to evaluate the surgical outcomes in patients with thoracic OPLL according to dekyphosis procedure and to identify predictive factors for the surgical results. Methods : A total of 25 patients with thoracic OPLL who underwent surgery for myelopathy from May 2004 to March 2017, were retrospectively reviewed. Patients with cervical myelopathy were excluded. We assessed the clinical outcomes according to various surgical approaches. The modified Japanese orthopedic association (JOA) scores for the thoracic spine (total, 11 points) and JOA recovery rates were used for investigating surgical outcomes. Results : Of the 25 patients, 10 patients were male and the others were female. The mean JOA score was 6.7±2.3 points preoperatively and 8.8±1.8 points postoperatively, yielding a mean recovery rate of 53.8±31.0%. The mean patients' age at surgery was 52.4 years and mean follow-up period was 40.2 months. According to surgical approaches, seven patients underwent anterior approaches, 13 patients underwent posterior approaches, five patients underwent combined approaches. There was no significant difference of the surgical outcomes related with different surgical approaches. Age (≥55 years) and high signal intensity on preoperative magnetic resonance (MR) image in the thoracic spine were significant predictors of the lower recovery rate after surgery (p<0.05). Posterior decompression with dekyphosis procedure was related to the excellent surgical outcomes (p=0.047). Dekyphosis did not affect the complication rates. Conclusion : In this study, our result elucidated that old age (≥55 years) and presence of intramedullary high signal intensity on preoperative MR images were risk factors related to poor surgical outcomes. In the meanwhile, posterior decompression with dekyphosis affected favorable clinical outcome. Posterior approach with dekyphosis procedure can be a recommendable surgical option for favorable results.

• The Journal of Korean Medicine
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• v.37 no.4
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• pp.45-48
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• 2016

Objectives: A diagnostic imaging in a fifty five year-old woman diagnosed orthopedically as ossification of posterior longitudinal ligament (OPLL) at C5 and C6 levels was reinterpreted for Chuna mannual therapy. The cervical spinal lesion in simple X-ray and CT scan images was discussed by spinal listing systems and disc block subluxation theory. The primary adjustive target was C4 disc block subluxation, which had been affected by kyphosis. Chuna manual therapy based on diagnostic images could be helpful for adjusting spinal subluxation, correcting its adaptation curvature, and preventing its latent pathology efficiently.