Heterotopic ossification in the posterior longitudinal ligament (OPLL) predisposes the patient to progressive narrowing of the spinal canal and/or abutment of the spinal cord. OPLL commonly presents in the fifth or sixth decade of life with a 2:1 male-to-female ratio. OPLL of the cervical spine is more common than thoracic OPLL, which was confirmed in a survey of 1,058 patients with OPLL, of whom 3.2% demonstrated involvement of the cervical spine and 0.8%, the thoracic spine [117]. Although original estimates of OPLL prevalence were based on lateral radiographs of the spine, more recently reported prevalence rates based on CT report prevalence rates of cervical OPLL between 1.7% in the white United States population and 4.6% in the Korean population [118,119]. CT Cervical Spine Although radiographs are helpful in the diagnosis of OPLL, particularly in the cervical region, CT is more reliable both in the identification of OPLL and in the evaluation of sequelae related to its diagnosis [120]. CT evaluation can show OPLL type, thickness, length of involved segments, and associated systemic diseases, such as diffuse idiopathic skeletal hyperostosis. The superior spatial resolution of CT helps identify regions of neuroforaminal and spinal canal narrowing and should be considered in any patient presenting with new or worsening radiculopathy in the setting of suspected OPLL. CT Myelography Cervical Spine CT myelography performed in flexion and extension has been described to help identify regions of position- dependent cord compression related to cervical spinal stenosis from OPLL [121], although it is not routinely used in clinical practice. CTA Neck The literature search did not identify any studies regarding the use of CTA in the evaluation of this clinical presentation.
Cervical Neck Pain or Cervical Radiculopathy PCAs. Heterotopic ossification in the posterior longitudinal ligament (OPLL) predisposes the patient to progressive narrowing of the spinal canal and/or abutment of the spinal cord. OPLL commonly presents in the fifth or sixth decade of life with a 2:1 male-to-female ratio. OPLL of the cervical spine is more common than thoracic OPLL, which was confirmed in a survey of 1,058 patients with OPLL, of whom 3.2% demonstrated involvement of the cervical spine and 0.8%, the thoracic spine [117]. Although original estimates of OPLL prevalence were based on lateral radiographs of the spine, more recently reported prevalence rates based on CT report prevalence rates of cervical OPLL between 1.7% in the white United States population and 4.6% in the Korean population [118,119]. CT Cervical Spine Although radiographs are helpful in the diagnosis of OPLL, particularly in the cervical region, CT is more reliable both in the identification of OPLL and in the evaluation of sequelae related to its diagnosis [120]. CT evaluation can show OPLL type, thickness, length of involved segments, and associated systemic diseases, such as diffuse idiopathic skeletal hyperostosis. The superior spatial resolution of CT helps identify regions of neuroforaminal and spinal canal narrowing and should be considered in any patient presenting with new or worsening radiculopathy in the setting of suspected OPLL. CT Myelography Cervical Spine CT myelography performed in flexion and extension has been described to help identify regions of position- dependent cord compression related to cervical spinal stenosis from OPLL [121], although it is not routinely used in clinical practice. CTA Neck The literature search did not identify any studies regarding the use of CTA in the evaluation of this clinical presentation.