Early Detection of Ossification of the Posterior Longitudinal Ligament (OPLL) in Patients with Degenerative Cervical Myelopathy (DCM)
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https://doi.org/10.19166/lijn.v2i2.11443##semicolon##
Modified Japanese Orthopaedic Association Score (mJOA)##common.commaListSeparator## Degenerative Cervical Myelopathy##common.commaListSeparator## Ossification of Posterior Longitudinal Ligament##common.commaListSeparator## Nurick Classification of Myelopathy##common.commaListSeparator## Conservative Treatment##common.commaListSeparator## Surgical Intervention초록
Introduction: Degenerative changes in the cervical spine leads to Degenerative Cervical Myelopathy (DCM). Ossification of posterior longitudinal ligament (OPLL) is a common cause of DCM in Asian populations and causes severe neurological deficits, which significantly impairs quality of life.
Case Presentation: A 49-year-old Sunda woman presented with progressive numbness and tingling sensation followed by progressive weakness in the lower extremities. Progressive weakness then developed in the upper extremities. Physical examination revealed tetraparesis and reflexes increased in all extremities. Sensory examination revealed hypoesthesia in the right T5-T12 dermatome, and bilateral L1-S2 dermatome. She was assessed as grade 3 Nurick classification of myelopathy and has a Modified Japanese Orthopaedic Association Score (mJOA) Score of 15. Non-contrast Cervical magnetic resonance imaging (MRI) revealed continuous OPLL type at C3-C5 level. She received high dose intravenous methylprednisolone and was referred to another hospital for surgery.
Discussion: OPLL has not been documented extensively in Indonesia. Early detection of DCM can be done with a mJOA score of ≤16. Conservative treatment is recommended for minimally symptomatic or high-risk surgery patients. Surgical intervention has shown significant improvement in clinical outcome, although it is not beneficial in absent or minimal myelopathy (Nurick grade 1 or 2).
Conclusions: OPLL is a common cause of DCM in Asian populations. Early detection using mJOA is paramount to achieve better recovery. Conservative treatment is done for mild DCM while surgical intervention is done in moderate to severe DCM.
Keywords: Conservative Treatment, Degenerative Cervical Myelopathy (DCM), Modified Japanese Orthopaedic Association Score (mJOA), Nurick Classification of Myelopathy, Ossification of Posterior Longitudinal Ligament (OPLL), Surgical Intervention
##submission.citations##
1. Klumb S, Haley L, Hathaway C, Irby J, Cheng J, Rumley J. Degenerative Cervical Myelopathy Diagnosis and Its Differentiation from Neurological Mimics, MS and ALS: A Literature Review. J Clin Med. 2025;14(24):8711. https://doi.org/10.3390/jcm14248711
2. Alyosef E, Mohsin M, Ali M, Gibrata Q, George BT. Posterior Longitudinal Ligament Calcification with Myelopathy - A Case Report. New Emirates Med J. 2024 Jan 1;5:e02506882280315231227033125. https://doi.org/10.2174/0102506882280315231227033125
3. Wang J, Wei Z, Kong Q, Sun Y, Zhang Z, Yang H, et al. The relationship between OPLL and metabolic disorders. Bone Res. 2025 Oct 24;13(1):90. https://doi.org/10.1038/s41413-025-00446-9
4. Sun XF, Wang Y, Sun JC, Xu XM, Kong QJ, Chen Y, et al. Consensus statement on diagnosis and treatment of cervical ossification of posterior longitudinal ligament from Asia Pacific Spine Society (APSS) 2020. J Orthop Surg (Hong Kong). 2020 Dec;28(3):2309499020979029. https://doi.org/10.1177/2309499020979029
5. Head J, Rymarczuk G, Stricsek G, Velagapudi L, Maulucci C, Hoelscher C, et al. Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications. Neurospine. 2019 Sep;16(3):517-528. https://doi.org/10.14245/ns.1938290.145
6. Gill M, Maheshwari V, Yadav AK, Gadhavi R. A Clinicoradiological Assessment following Surgical Intervention in Patients of Cervical Spondylotic Myelopathy: An Institutional Experience. Indian J Neurosurg. 2022 Dec;11(3):241–247. https://doi.org/10.1055/s-0042-1750000
7. Koike Y, Takahata M, Nakajima M, Otomo N, Suetsugu H, Liu X, et al. Genetic insights into ossification of the posterior longitudinal ligament of the spine. Elife. 2023 Jul 18;12:e87309. https://doi.org/10.7554/eLife.87309
8. Okawa Y, Mitsuhashi T, Tsuda T. The Asia-Pacific Body Mass Index Classification and New-Onset Chronic Kidney Disease in Non-Diabetic Japanese Adults: A Community-Based Longitudinal Study from 1998 to 2023. Biomedicines 2025, Vol 13,. 2025 Feb 5;13(2). https://doi.org/10.3390/biomedicines13020373
9. Choo YN, Ravi RN, Subramaniyan V. Insulin resistance induced by obesity: Mechanisms, metabolic implications and therapeutic approaches. Molecular Biology Reports 2026 53:1. 2026 Feb 4;53(1):357-. https://doi.org/10.1007/s11033-026-11509-3
10. Hirai T, Yoshii T, Ushio S, Hashimoto J, Mori K, Maki S, et al. Associations between Clinical Symptoms and Degree of Ossification in Patients with Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multi-Institutional Cross-Sectional Study. Journal of Clinical Medicine 2020, Vol 9,. 2020 Dec 15;9(12). https://doi.org/10.3390/jcm9124055
11. Hirai T, Yoshii T, Hashimoto J, Ushio S, Mori K, Maki S, et al. Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study). Journal of Clinical Medicine 2022, Vol 11,. 2022 Jun 27;11(13). https://doi.org/10.3390/jcm11133694
12. Haddas R, Patel S, Arakal R, Boah A, Belanger T, Ju KL. Spine and lower extremity kinematics during gait in patients with cervical spondylotic myelopathy. Spine Journal. 2018 Sep 1;18(9):1645–52. https://doi.org/10.1016/j.spinee.2018.04.006
13. Tetreault L, Nakashima H, Kato S, Kryshtalskyj M, Nagoshi N, Nouri A, et al. A Systematic Review of Classification Systems for Cervical Ossification of the Posterior Longitudinal Ligament. Global Spine J. 2018 Feb 1;9(1):85. https://doi.org/10.1177/2192568217720421
14. Tetreault L, Kopjar B, Nouri A, Arnold P, Barbagallo G, Bartels R, et al. The modified Japanese Orthopaedic Association scale: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy. Eur Spine J. 2017 Jan;26(1):78–84. https://doi.org/10.1007/s00586-016-4660-8
15. Treanor C, Gallagher C, Lenehan W, Gantly H, Bolger C, Malone A. Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy. Brain Spine. 2024;4:102853. https://doi.org/10.1016/j.bas.2024.102853
16. Levett JJ, Georgiopoulos M, Martel S, Mugheiry W al, Stavropoulos NA, Vega-Arroyo M, et al. Pharmacological Treatment of Degenerative Cervical Myelopathy: A Critical Review of Current Evidence. Neurospine. 2024 Jun 1;21(2):375–400. https://doi.org/10.14245/ns.2448140.070
17. Sun N, Jiang C, Liu Y. Surgical options for ossification of the posterior longitudinal ligament of the cervical spine: a narrative review. J Orthop Surg Res. 2024 Dec 1;19(1):707. https://doi.org/10.1186/s13018-024-05183-z
