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Background <p>Both genetic and environmental (e.g., mechanical stress) factors have been considered multifactorial components contributing to the development and progression of ossification of posterior longitudinal ligament (OPLL). Importantly, loss of cervical lordosis may change the mechanical stress on posterior longitudinal ligament. However, few studies have discussed the relationship between the cervical sagittal alignment and OPLL. The aim of this study is to quantify the cervical sagittal alignment and severity of ligament ossification in patients with cervical OPLL and to analyze their correlation.</p> Methods <p>Cervical sagittal alignment was measured in 142 patients and 90 healthy subjects. All patients underwent assessments of the degree of ligament ossification and the severity of cervical cord injury. Finite element models of cervical lordosis, straightness and kyphosis were established, and the mechanical tension of the posterior longitudinal ligament was compared among the different models.</p> Results <p>There was no difference of all measurements of cervical sagittal alignment between the normal control and patient groups (<i>P</i> &gt; 0.05). Subgroup analysis demonstrated that the cervical OPLL patients in cervical kyphotic group showed greater OPLL ossification index (OP-index) and higher density [Hounsfeld unit (HU)] of ossified ligament compared to cervical lordotic group (<i>P</i> &lt; 0.05). Furthermore, in the cervical kyphotic subgroup, the C2-7 Cobb angle was associated with both the OP-index (<i>r</i>=-0.61, <i>P</i> &lt; 0.05) and the HU value (<i>r</i>=-0.78, <i>P</i> &lt; 0.05), and there was a relationship between the C7 slope and HU value (<i>r</i>=-0.66, <i>P</i> &lt; 0.05) in this subgroup. However, there was no relationship between the cervical sagittal alignment and OPLL severity in both cervical lordotic and straight groups (<i>P</i> &gt; 0.05). Furthermore, the tension of posterior longitudinal ligament was greater in cervical kyphotic model than that in the other two models (<i>P</i> &lt; 0.05).</p> Conclusions <p>There was a relationship between the loss of cervical sagittal alignment and both the degree and size of cervical OPLL in the cervical kyphosis subgroups in patients with OPLL. Therefore, it is necessary for clinicians to be aware of cervical sagittal alignment during cervical OPLL treatment, especially in patients with kyphosis.</p>

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The correlation between loss of cervical lordosis and the severity of ligament ossification in patients with cervical ossification of posterior longitudinal ligament: a cross-sectional observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月20日

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  • Kaiwen Chen,
  • Shenyan Gu,
  • Yaqing Guo,
  • Yu Zhu,
  • Feizhou Lyu,
  • Jianyuan Jiang,
  • Xiaosheng Ma,
  • Xinlei Xia,
  • Chaojun Zheng

摘要

Background

Both genetic and environmental (e.g., mechanical stress) factors have been considered multifactorial components contributing to the development and progression of ossification of posterior longitudinal ligament (OPLL). Importantly, loss of cervical lordosis may change the mechanical stress on posterior longitudinal ligament. However, few studies have discussed the relationship between the cervical sagittal alignment and OPLL. The aim of this study is to quantify the cervical sagittal alignment and severity of ligament ossification in patients with cervical OPLL and to analyze their correlation.

Methods

Cervical sagittal alignment was measured in 142 patients and 90 healthy subjects. All patients underwent assessments of the degree of ligament ossification and the severity of cervical cord injury. Finite element models of cervical lordosis, straightness and kyphosis were established, and the mechanical tension of the posterior longitudinal ligament was compared among the different models.

Results

There was no difference of all measurements of cervical sagittal alignment between the normal control and patient groups (P > 0.05). Subgroup analysis demonstrated that the cervical OPLL patients in cervical kyphotic group showed greater OPLL ossification index (OP-index) and higher density [Hounsfeld unit (HU)] of ossified ligament compared to cervical lordotic group (P < 0.05). Furthermore, in the cervical kyphotic subgroup, the C2-7 Cobb angle was associated with both the OP-index (r=-0.61, P < 0.05) and the HU value (r=-0.78, P < 0.05), and there was a relationship between the C7 slope and HU value (r=-0.66, P < 0.05) in this subgroup. However, there was no relationship between the cervical sagittal alignment and OPLL severity in both cervical lordotic and straight groups (P > 0.05). Furthermore, the tension of posterior longitudinal ligament was greater in cervical kyphotic model than that in the other two models (P < 0.05).

Conclusions

There was a relationship between the loss of cervical sagittal alignment and both the degree and size of cervical OPLL in the cervical kyphosis subgroups in patients with OPLL. Therefore, it is necessary for clinicians to be aware of cervical sagittal alignment during cervical OPLL treatment, especially in patients with kyphosis.