Chang, KC

Cheung, KMC

Luk, KDK

Samartzis, D

Hong Kong Medical Journal

HKU Scholars Hub

Title Cervical spine disease in Asian populationsAuthor(s) Chang, KC; Samartzis, D; Luk, KDK; Cheung, KMCCitation Hong Kong Medical Journal, 2010, v. 16 n. 1, p. 69-70Issued Date 2010URL http://hdl.handle.net/10722/92909Rights Creative Commons: Attribution 3.0 Hong Kong License	 Hong	Kong	Med	J		Vol	16	No	1	#	February	2010	#		www.hkmj.org	 69Case illustrationA 53-year-old male of Southern Chinese descent presented to an orthopaedic clinic with a 3-week history of paraesthesiae in all extremities and left-sided upper and lower limb weakness. He had no neck symptoms. A physical examination revealed a positive Romberg’s sign, an unstable gait, clumsy hand functions, brisk reflexes in all four limbs and up-going plantar responses. His power was mildly reduced to 4/5 in his left upper and lower extremities and his sensation was reduced bilaterally from C4 down. His Japanese Orthopaedic Association (JOA) score was 9.5 out of 17 (the lower the score the worse the function). Plain radiographs and magnetic resonance images (MRI) of his cervical spine were assessed (Figs 1 and 2).What is your diagnosis?a. Congenital narrowing of the cervical spinal canalb. Diffuse idiopathic skeletal hyperostosisc. Cervical spondylotic myelopathyd. Ossified yellow ligamente. Ossified posterior longitudinal ligamentf. Multiple level disc prolapseCervical spine disease in Asian populationsP I C T O R I A LM E D I C I N EDiscussionThe diagnosis was cervical myelopathy secondary to an ossified posterior longitudinal ligament (OPLL) from C2 to C7. It was managed surgically with an expansive cervical laminoplasty. The patient recovered all motor function, but had residual paraesthesiae in his fingertips 3 months after surgery. An OPLL is a common problem among Japanese and seen to a lesser extent in other Asian populations, but is rare in Caucasians.1,2 This condition is a heterotrophic ossification of the posterior longitudinal ligament of the spine, occurring predominantly in the cervical spine. It causes progressive anterior compression of the spinal cord, which manifests clinically as chronic cervical myelopathy. Most patients present with paraesthesiae in their hands and feet, clumsy fine motor hand functions, and unsteady, spastic gaits. Many patients are asymptomatic because the spinal cord has high tolerance to slowly increasing mechanical compression due to canal accommodation. Nonetheless, patients with OPLL are susceptible to minor trauma, which readily causes acute tetraplegia.1 Making a clinical diagnosis of cervical FIG 1.  Lateral X-ray of the cervical spine FIG 2.  T2-weighted sagittal magnetic resonance image of the cervical spine		#		Chang	et	al	#70	 Hong	Kong	Med	J		Vol	16	No	1	#	February	2010	#		www.hkmj.orgReferences1.	 Hirabayashi	K,	Miyakawa	J,	Satomi	K,	Maruyama	T,	Wakano	K.	Operative	results	and	postoperative	progression	of	ossification	among	patients	with	ossification	of	cervical	posterior	longitudinal	ligament.	Spine	(Phila	Pa	1976)	1981;6:354-64.2.	 Ogawa	Y,	Chiba	K,	Matsumoto	M,	et	al.	 Long-term	 results	after	expansive	open-door	 laminoplasty	 for	 the	 segmental-type	of	ossification	of	the	posterior	longitudinal	ligament	of	the	cervical	spine:	a	comparison	with	nonsegmental-type	lesions.	J	Neurosurg	Spine	2005;3:198-204.3.	 Matsunaga	 S,	Nakamura	 K,	 Seichi	A,	 et	 al.	 Radiographic	 predictors	 for	 the	 development	 of	myelopathy	 in	 patients	with	ossification	of	the	posterior	longitudinal	ligament:	a	multicenter	cohort	study.	Spine	(Phila	Pa	1976)	2008;33:2648-50.4.	 Mizuno	 J,	 Nakagawa	H.	 Outcome	 analysis	 of	 anterior	 decompressive	 surgery	 and	 fusion	 for	 cervical	 ossification	 of	 the	posterior	longitudinal	ligament:	report	of	107	cases	and	review	of	the	literature.	Neurosurg	Focus	2001;10:E6.5.	 Seichi	A,	Takeshita	K,	Ohishi	I,	et	al.	Long-term	results	of	double-door	laminoplasty	for	cervical	stenotic	myelopathy.	Spine	(Phila	Pa	1976)	2001;26:479-87.myelopathy is simple when there are upper motor neuron signs in all four limbs and pathognomonic Hoffmann, reverse brachio-radialis and scapulo-humeral reflexes, 10-second test, and finger escape signs. Ossification is readily seen in standard X-rays and computed tomographic scans, and is classified into segmental, continuous, or mixed types. Spinal cord compression can be assessed using MRI.1,3 The JOA scores are used to monitor clinical disability. Surgery is usually indicated in order to improve function and prevent further neurological deterioration, which may even manifest as sudden, catastrophic tetraplegia.1,2,4,5 The available surgical options are numerous, but largely dependent on the extent and characteristics of the OPLL pathology, and additional co-morbidities. Surgical correction may entail posterior expansive cervical laminoplasty, posterior laminectomy with instrumented fusion, and anterior decompression with strut grafting, with or without instrumentation.1,2,4,5 The extent of clinical recovery usually depends on the patient’s age, the severity and duration of the symptoms, the degree of compression, and the operative method.1,2,5 An accurate diagnosis of OPLL is essential for understanding the pathological mechanism underlying the clinical manifestation and to enable the good clinical decision-making needed to achieve an optimal outcome.KC Chang, MB, BS, MS (Ortho)Dino Samartzis, DSc, MScKeith DK Luk, MB, BS, FHKAM (Orthopaedic Surgery)Kenneth MC Cheung, MD, FHKAM (Orthopaedic Surgery)Email: ken-cheung@hku.hkDepartment of Orthopaedics and TraumatologyQueen Mary HospitalThe University of Hong KongPokfulamHong Kong

Cervical spine disease in Asian populations

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Cervical spine disease in Asian populations

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