J Korean Neurosurg Soc.  2015 Nov;58(5):442-447. 10.3340/jkns.2015.58.5.442.

The Clinical Significance of Ossification of Ligamentum Nuchae in Simple Lateral Radiograph : A Correlation with Cervical Ossification of Posterior Longitudinal Ligament

• Kim DG
• Oh YM
• Eun JP

• KMID: 2191409
• DOI: http://doi.org/10.3340/jkns.2015.58.5.442

Abstract

OBJECTIVE
Ossification of the ligamentum nuchae (OLN) is usually asymptomatic and incidentally observed in cervical lateral radiographs. Previous literatures reported the correlation between OLN and cervical spondylosis. The purpose of this study was to elucidate the clinical significance of OLN with relation to cervical ossification of posterior longitudinal ligament (OPLL).
METHODS
We retrospectively compared the prevalence of OPLL in 105 patients with OLN and without OLN and compared the prevalence of OLN in 105 patients with OPLL and without OPLL. We also analyzed the relationship between the morphology of OLN and involved OPLL level. The OPLL level was classified as short (1-3) or long (4-6), and the morphologic subtype of OLN was categorized as round, rod, or segmented.
RESULTS
The prevalence of OPLL was significantly higher in the patients with OLN (64.7%) than without OLN (16.1%) (p=0.0001). And the prevalence of OLN was also higher in the patients with OPLL (54.2%) than without OPLL (29.5%) (p=0.0002). In patients with round type OLN, 5 of 26 (19.2%) showed long level OPLL, while in patients with larger type (rod and segmented) OLN, 22 of 42 (52.3%) showed long level OPLL (p=0.01).
CONCLUSION
There was significant relationship between OLN and OPLL prevalence. This correlation indicates that there might be common systemic causes as well as mechanical causes in the formation of OPLL and OLN. The incidentally detected OLN in cervical lateral radiograph, especially larger type, might be helpful to predict the possibility of cervical OPLL.

Keyword

Ossification of ligamentum nuchae; Ossification of posterior longitudinal ligament; Spinal ligament ossification syndrome; Cervical spine

MeSH Terms

Humans
Ossification of Posterior Longitudinal Ligament*
Prevalence
Retrospective Studies
Spondylosis

Figure

• 

  Fig. 1 Simple cervical lateral films of OPLL patients. A : A 52-year-old male patient with round type OLN (arrow). B : A 61-year-old male patient with rod type OLN (arrow). C : A 55-year-old male patient with segmented type OLN (arrow). As the type of OLN changes from round to rod to segmented, the size of OLN increases at the sagittal plane. OPLL : ossification of posterior longitudinal ligament, OLN : ossification of nuchal ligament.

• 

  Fig. 2 Computed tomography of OPLL patients shows that patients with larger OLN are more prone to having multiple levels of OPLL. A : A 55-year-old male patient has round type OLN (white arrow) with short level OPLL at the C4, 5 (black arrow). B : A 52-year-old male patient has segmented type OLN (white arrow) with long level OPLL at the C4-7 (black arrow). OPLL : ossification of posterior longitudinal ligament, OLN : ossification of nuchal ligament.

• 

  Fig. 3 The level of ossification was determined by the horizontal line along the endplate of each vertebral body.

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