Immunohistochemistry of symptomatic hypertrophy of the posterior longitudinal ligament with special reference to ligamentous ossification
Spinal Cord, ISSN: 1362-4393, Vol: 44, Issue: 9, Page: 576-581
2006
- 38Citations
- 26Captures
- 1Mentions
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- Citations38
- Citation Indexes38
- 38
- CrossRef29
- Captures26
- Readers26
- 26
- Mentions1
- News Mentions1
- 1
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51-year-old woman with cervical myelopathy, posterior longitudinal ligament ossification
A 51-year-old woman with no past medical history and on no medications presented to the office with a several-month history of left arm numbness, weakness in the bilateral lower extremities and gait instability. On physical examination, the patient ambulated with a wide-based gait and had mild limitation in cervical spine range of motion, particularly extension. Sensory and motor testing revealed
Article Description
Study design: Immnunohistochemical staining of the thickened posterior longitudinal ligament of the cervical spine. Objectives: To clarify the histological characteristics of hypertrophy of the posterior longitudinal ligament (HPLL) of the cervical spine and the relationship between HPLL and ossification of the posterior longitudinal ligament (OPLL). Setting: Aichi Medical University, Aichi, Japan. Methods: Eight specimens of HPLL and two of OPLL were obtained during anterior decompressive surgery on the cervical spine from patients with myelopathy. Hematoxylin and eosin staining, alcian blue staining and immunohistochemical staining with antibodies against bone morphogenetic protein (BMP), transforming growth factor (TGF)-β, proliferating cell nuclear antigen (PCNA), alkaline phosphatase (ALP) and osteopontin (OPN) were carried out on the specimens. Results: HPLL showed hyalinoid degeneration, the proliferation of chondrocytes and fibroblast-like spindle cells, infiltration of vessels and small ossification. In four cases, chondroid tissue was prominent with chondrocytes, which were expressed by ALP and OPN. The cells in HPLL were weakly or moderately stained by BMP, TGF-β and PCNA. Their expression was similar to that of OPLL. Immunohistochemical staining was negative for all cells in the control cases. Conclusions: Histological and biochemical evidence supports the hypothesis that HPLL transforms into OPLL. The positive expression of BMP and TGF-β in HPLL cells of myelopathic patients, and their similarity to OPLL, suggest that these cells have the potential to differentiate into osteogenic cells. Of note, neither BMP nor TGF-β was demonstrated in the PLL of control subjects. Furthermore, the expression of chondrocytes by ALP and OPN in cartilage-prominent HPLL suggests that the cartilage can be replaced by new bone. © 2006 International Spinal Cord Society. All rights reserved.
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