MRI is also less sensitive for identifying small ossifications and thickened or folded ligamentum flavum [ 4 , 10 ]. CT has been shown to have higher sensitivity for identifying OSL and is more likely to discover the actual prevalence of OSL [ 14 , 16 , 26 , 35 ]. Several reports have shown that tandem ossification is not uncommon in people with OSL [ 16 , 36 , 37 ]. Hirai et al. Fujimori et al. It can be found that subjects with OPLL generally have a predisposition to coexist with multiple-regional lesions.
Missed multiple-regional lesions can lead to serious consequences. Takeuchi et al. We suggest that it is not necessary to use whole spine CT as a routine screening. The results of the multiple regression analysis revealed that males are three times more likely to suffer from DISH.
Consistent with previous evidence [ 6 , 16 , 32 , 40 , 41 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], female preponderance of T-OPLL and male preponderance of DISH were confirmed. In Japan and Korea, the prevalence has been considered to have a male predominance of roughly to [ 50 ]. Although eastern Asians are thought to be genetically similar, the discrepancy could be attributed to different reasons, such as age distribution, sex ratio, sample size, target population, or selection bias.
In addition, lifestyle factors and dietary habits, including bad sleeping habits [ 51 ], high-salt and low-protein diet [ 52 ], were associated with an increased risk of OPLL. Some studies have shown that the coexistence of other disorders such as obesity [ 53 ], diabetes mellitus [ 54 ], hypoparathyroidism [ 5 ], and hormonal imbalance [ 55 ], are contributory factors in OPLL. Therefore, these multiple factors may lead to different results.
But the results regarding the gender difference in T-OLF prevalence are inconsistent. Four studies [ 4 , 10 , 16 , 29 ] showed that T-OLF occurs predominantly in men, while two others [ 9 , 31 ] showed the opposite result. In this study, T-OLF was significantly more common in women men Additional large-scale, multi-center studies is therefore necessary to confirm the cause for these differences. Our study showed the mean age of people with ossifications was significantly higher than those without. OSL is more prevalent in the older age group.
This finding suggests that degeneration factor might affect the development of OSL. Similarly, Kim et al. Because thoracic spine with greater TK often accompanied by higher tensile force. In the present study, T-OLF most frequently located in lower thoracic segments T9—T12 and the second most frequent location was the upper thoracic segments T2—T5. Several studies considered that these locations are transitional areas in terms of spinal curvature, where is the area of high stress concentration [ 2 , 4 , 9 , 10 ]. Therefore, it is possibly more prone to degeneration because of the high tensile forces.
What is ossification of posterior longitudinal ligament?
The present study has several limitations. First, the study population was not randomly selected and not purely based on the general population. All individuals were collected in a tertiary, multi-specialty referral hospital, which inevitably creates a sample selection bias.
However, it is considered unethical to perform whole body CT for normal volunteers due to the radiation exposure. Second, there are 59 subjects 3. Incidence of cancer in our study was higher than the real cancer morbidity [ 56 ]. But through statistical analysis, we found that there is no significant difference in the prevalence of spinal ligament ossification between cancer-positive subjects and cancer-negative subjects data not shown.
Third, there is no information regarding the clinical presentation of OSL in this screening population. We could not evaluate the association between OSL and related clinical manifestations. Fourth, spinal sagittal parameters measured from supine position may be underestimated compared with standing position. In addition, OSL can have an influence on the flexibility of the spinal column, so there may be a limitation for measuring spinal sagittal parameters in the supine position.
Nevertheless, considering the difficulty in obtaining whole body CT data in a large general population, we think that our data, to some extent, reflects the prevalence of OSL in the general population of China. The prevalence of spinal ligament ossifications in Chinese was revealed and roughly consistent with other eastern Asians.
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Tsuyama N. Ossification of the posterior longitudinal ligament of the spine. Clin Orthop Relat Res. Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis DISH. Variability in Cobb angle measurements using reformatted computerized tomography scans. The measurement of observer agreement for categorical data. Matsunaga S, Sakou T. Ossification of the posterior longitudinal ligament of the cervical spine: etiology and natural history. A radiological population study on the ossification of the posterior longitudinal ligament in the spine.
Arch Orthop Trauma Surg. Prevalence and progression of radiographic ossification of the posterior longitudinal ligament and associated factors in the Japanese population: a 3-year follow-up of the ROAD study. Osteoporos Int.
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