Ossification of the Posterior Longitudinal Ligament (OPLL)
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What is OPLL?
Ossification of the Posterior Longitudinal Ligament is a medical condition where the flexible connective tissue of the spine becomes thickened, hardened, inflexible and eventually turns into “bone”. It has an idiopathic onset, which means it arises spontaneously and the cause is generally unknown. Although it is believed that there are genetic, hormonal, environmental and lifestyle factors that may play a role in its origin.
OPLL most commonly affects the cervical spine (the neck) but can present anywhere along the posterior longitudinal ligament of the spine. OPLL typically begins with no or mild symptoms and slowly worsens as the connective tissues progress towards becoming “bone”. The space (spinal canal) where nerves and the spinal cord travel though may become impinged which potentially leads to nerve and spinal cord compression.
Depending on the structures which are compressed symptoms may present such as:
Pain in the neck and travelling down an arm
Pins and needles or numbness of the upper limbs or hands
Dysesthesia (abnormal sense of touch) or Allodynia (pain due to stimulus that does not normally provoke pain)
Weakness in the upper limb
Clumsy hands, problems with dexterity and fine motor
Balance problems and difficulties with walking
Bladder and bowel issues
Sensory loss
Altered muscle tone
Widespread Muscle weakness
Treatment
OPLL is usually treated through a multidisciplinary team inclusive of a General Practitioner, neurologist, physiotherapist, occupational therapist, and neurological surgeon or orthopaedic spine surgeon. In the initial stages of OPLL, a general practitioner and neurologist, will likely treat the signs and symptoms conservatively using a combination of pain management and anti-inflammatory medications. Individuals with OPLL should be closely monitored to ensure the compression does not become severe and cause more pronounced and permanent signs and symptoms. During conservative management an individual may also be given precautions to limit the risk of injury. These may include avoiding whiplash like injuries, avoid being in an extended neck position (painting ceiling), or lifting to heavy of weight.
With disease progression, OPLL may be managed through surgical intervention by a neurosurgeon or orthopaedic spinal surgeon where they decompress the area around the affected nerves or spinal cord.
HOW CAN PHYSIOTHERAPY AND OCCUPATIONAL THERAPY HELP WITH OPLL?
Physiotherapy and Occupational Therapy will complete a comprehensive assessment to better understand what may be affected from the OPLL and then design a program to try and improve or manage the signs and symptoms. Treatment may consist of education, an individualised strengthening program, fine motor and dexterity training, pain management strategies, balance program, gait retraining, and/or prescription of assistive technologies or aids.
References:
Choi BW, Song KJ, Chang H. Ossification of the posterior longitudinal ligament: a review of literature. 5 (4): 267-76. Asian Spine J. 2011.
Epstein N. Diagnosis and surgical management of cervical ossification of the posterior longitudinal ligament. 2 (6): 436-49. Spine J. 2003.
Saetia K, Cho D, Lee S, Kim DH, Kim SD. Ossification of the posterior longitudinal ligament: A Review. 30 (3), E1. Journal Of Neurosurgery.2011.
Shunji M, Takashia S. Ossification of the posterior longitudinal ligament of the Cervical Spine: Aetiology and Natural History. 37 (5), p E309 – 314. Spine J. 2012.
Smith ZA, Buchanan CC, Raphael D et-al. Ossification of the posterior longitudinal ligament: pathogenesis, management, and current surgical approaches. A review. 30 (3): E10. Neurosurg Focus. 2011.
Stapleton CJ, Pham MH, Attenello FJ, Hsieh PC. Ossification of the posterior longitudinal ligament: genetics and pathophysiology, 30(3), E1. Journal of Neurosurgery. 2011.