1. OPLL Upper Chesapeake Medical Center Spine Conference August 1, 2014

2. 86 year old woman cc: R arm weakness 10 day H/O progressive weakness in the R>L upper extremity Sent from PCP to ER on 7/1/14. Dropping objects, no fine motor, R hand feels worthless, RHD, has to hold a cup with both hands PMH: hypothyroidism, addisons dz, UTI, cataract, T6T10 lami/PSF 2012, diverticulosis EXAM: 5 feet 142 lb, ataxia on exam, clumsiness in R hand Presented to office on 7/14/14 with progressive symptoms 3. Ataxic gait 4. Finger escape sign 5. ER visit CT 6. c2 C3 C3C4 C4C5 7. Ossification of the Posterior Longitudinal Ligament OPLL 5-6th decade 2:1 M:F 50% of Caucasians have DISH Risk Factors: hypoparathyroidism, hypophosphatemic rickets, hyperinsulinemia, obesity, high BMI 8. Risk Factors to progression >60% canal stenosis 6mm or less SAC Increased ROM cervical spine OPLL that is lateral 9. OPLL cells have features similar to osteoblasts 10. K line: kyphosis line; drawn from the center of the canal at C2 to center of the canal at C7, if the OPLL is posterior to the line (K- line negative) is a negative prognostic factor for posterior decompression 11. Double Layer Sign associated with 50% dural tear rates with ant approach 12. Nurick S. The pathogenesis of spinal cord disorder associated with cervical spondylosis. Brain 1972; 95: 87-100 13. 3 6 14. THANKS!!