Contraindications
Contraindications of OHPC include previous or current thrombosis or thromboembolic disease, known or suspected breast cancer, past or present history of other hormone-sensitive cancer, undiagnosed abnormal vaginal bleeding unrelated to pregnancy, cholestatic jaundice of pregnancy, liver tumors or active liver disease, and uncontrolled hypertension. A few relative contraindications also exist for OHPC. Side effects
OHPC is generally well tolerated and produces relatively few side effects. Injection site reactions such as pain, soreness, swelling, itching, bruising, and lumps are the most common side effect of OHPC. In contrast to large doses of progesterone however, which produce moderate-to-severe such reactions, OHPC is relatively free from injection site reactions. Side effects of OHPC that occur in greater than or equal to 2% of users include injection site pain (34.8%), injection site swelling (17.1%), urticaria (12.3%), pruritus (7.7%), injection site pruritus (5.8%), nausea (5.8%), injection site nodules (4.5%), and diarrhea (2.3%). Numerically increased rates relative to controls of miscarriage (2.4% vs. 0%), stillbirth (2.0% vs. 1.3%), admission for preterm labor (16.0% vs. 13.8%), preeclampsia or gestational hypertension (8.8% vs. 4.6%), gestational diabetes (5.6% vs. 4.6%), and oligohydramnios (3.6% vs. 1.3%) have been observed with OHPC in clinical trials in which it was given to pregnant women to prevent preterm birth. Overdose
There have been no reports of overdose of OHPC. In the event of overdose, treatment should be based on symptoms. OHPC has been studied in humans at high doses of 2,000 to 5,000 mg per week by intramuscular injection, without safety concerns.
Ossification of the posterior longitudinal ligament (OPLL) is a process of fibrosis, calcification, and ossification of the posterior longitudinal ligament of the spine, that may involve the spinal dura. Once considered a disorder unique to people of Asian heritage, it is now recognized as an uncommon disorder in a variety of patients with myelopathy. Causes
The causes of OPLL are unknown. However, genetic and environmental factors appear to play a role in pathogenesis. OPLL may also be associated with diffuse idiopathic skeletal hyperostosis

Diagnosis
Myeolography, including post-myelographic CT is likely the most effective imaging study an accurate diagnosis. Treatment
Surgical management options include extensive cervical laminectomy with or without an additional posterior arthrodesis, anterior decompression and arthrodesis, and posterior cervical laminoplasty. Treatment decisions can be made based on a grading systems devised by Hirabayashi et al., supplemented by the Nurick myelopathy classification system. Prognosis
Most patients suffer from only mild symptoms. Symptoms typically last approximately 13 months. Of patients without myelopathy at initial presentation, only 29% of them will develop myelopathy within 30 years. Epidemiology
The age range of patients with OPLL is from 32 to 81 years (mean = 53), with a male predominance. Prevalence is higher in those of Japanese or Asian ancestry (2-3.5%)  and rarer in other racial groups (0.16%). Schizophrenia patients in Japan may have as high as 20% incidence. References


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