Lecture posterior fusion for ossification of the posterior longitudinal ligament OPLL

1. OPLL
Upper Chesapeake Medical Center Spine Conference
August 1, 2014

2. 86 year old woman
cc: R arm weakness
10 day H/O progressive weakness in the R>L upper
extremity
Sent from PCP to ER on 7/1/14. Dropping objects, no fine
motor,
“R hand feels worthless”, RHD, has to hold a cup with both
hands
PMH: hypothyroidism, addisons dz, UTI, cataract, T6T10
lami/PSF
2012, diverticulosis
EXAM: 5 feet 142 lb, ataxia on exam, clumsiness in R hand
Presented to office on 7/14/14 with progressive symptoms

4. Ataxic gait

7. Finger escape sign

13. ER visit CT

19. c2
C3
C3C4
C4C5

28. Ossification of the Posterior
Longitudinal Ligament OPLL
• 5-6th decade
• 2:1 M:F
• 50% of Caucasians have DISH
• Risk Factors:
hypoparathyroidism,
hypophosphatemic rickets,
hyperinsulinemia, obesity,
high BMI

39. Risk Factors to
progression
• >60% canal
stenosis
• 6mm or less SAC
• Increased ROM
cervical spine
• OPLL that is lateral

40. OPLL cells have features similar to
osteoblasts

44. K line: kyphosis line; drawn from the center of the canal at C2 to
center of the canal at C7, if the OPLL is posterior to the line (K- line negative) is a negative prognostic factor for
posterior decompression

45. “Double Layer Sign” associated with 50% dural tear rates with ant approach

46. Nurick S. The pathogenesis of spinal cord disorder associated with cervical spondylosis.
Brain 1972; 95: 87-100

49. 3
6

56. THANKS!!