New classification system for ossification of the posterior longitudinal ligament using CT images

Yoshiharu Kawaguchi, Morio Matsumoto, Motoki Iwasaki, Tomohiro Izumi, Atsushi Okawa, Shunji Matsunaga, Kazuhiro Chiba, Takashi Tsuji, Masashi Yamazaki, Takahito Fujimori, Toshitaka Yoshii, Yoshiaki Toyama

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Ossification of the posterior longitudinal ligament (OPLL) is most frequently seen in the cervical spine. The types of cervical OPLL are classified into continuous, mixed, segmental, and other based on plain lateral X-ray. Computed tomography (CT) imaging is often used in clinical practice for evaluating ossified lesions as it can detect their precise location, size, and shape. However, to date, no CT classification of OPLL lesions has been proposed. Methods: One hundred and forty-four patients diagnosed with cervical OPLL by plain radiograph were included in this study. Sagittal and axial CT images of the cervical spine were obtained. We propose three classification systems: A, B, and axial. Classification A comprises two lesion types: bridge and nonbridge. Classification B requires examiners to describe all vertebral and intervertebral levels where OPLL exits in the cervical spine. Axial classification comprises central and lateral lesions identified on axial CT images. Seven observers evaluated CT images using this classification system, and intra- and interrater reliability were examined. Results: Averaged Fleiss' kappa coefficient of interrater agreement was 0.43 ± 0.26 among the seven observers, averaged intrarater reliability for the existence of OPLL was 72.4 ± 8.8 % [95 % confidence interval (CI) 67.5-76.8]. Fifty-four patients (37.5 %) had the bridge type and 90 the nonbridge type according to Classification A; 102 (70.8 %) had central and 42 (29.2 %) lateral OPLL in the axial classification. Four representative cases defined according to the three classification types are reported here. Conclusion: Subcommittee members of the Investigation Committee on the Ossification of the Spinal Ligaments of the Japanese Ministry of Public Health and Welfare propose three new classification systems of cervical OPLL based on CT imaging: A, B, and axial.

Original languageEnglish
Pages (from-to)530-536
Number of pages7
JournalJournal of Orthopaedic Science
Volume19
Issue number4
DOIs
Publication statusPublished - 01-01-2014
Externally publishedYes

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Ossification of Posterior Longitudinal Ligament
Tomography
Spine
Committee Membership
Ligaments
Osteogenesis
Public Health

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

Kawaguchi, Y., Matsumoto, M., Iwasaki, M., Izumi, T., Okawa, A., Matsunaga, S., ... Toyama, Y. (2014). New classification system for ossification of the posterior longitudinal ligament using CT images. Journal of Orthopaedic Science, 19(4), 530-536. https://doi.org/10.1007/s00776-014-0577-4
Kawaguchi, Yoshiharu ; Matsumoto, Morio ; Iwasaki, Motoki ; Izumi, Tomohiro ; Okawa, Atsushi ; Matsunaga, Shunji ; Chiba, Kazuhiro ; Tsuji, Takashi ; Yamazaki, Masashi ; Fujimori, Takahito ; Yoshii, Toshitaka ; Toyama, Yoshiaki. / New classification system for ossification of the posterior longitudinal ligament using CT images. In: Journal of Orthopaedic Science. 2014 ; Vol. 19, No. 4. pp. 530-536.
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title = "New classification system for ossification of the posterior longitudinal ligament using CT images",
abstract = "Background: Ossification of the posterior longitudinal ligament (OPLL) is most frequently seen in the cervical spine. The types of cervical OPLL are classified into continuous, mixed, segmental, and other based on plain lateral X-ray. Computed tomography (CT) imaging is often used in clinical practice for evaluating ossified lesions as it can detect their precise location, size, and shape. However, to date, no CT classification of OPLL lesions has been proposed. Methods: One hundred and forty-four patients diagnosed with cervical OPLL by plain radiograph were included in this study. Sagittal and axial CT images of the cervical spine were obtained. We propose three classification systems: A, B, and axial. Classification A comprises two lesion types: bridge and nonbridge. Classification B requires examiners to describe all vertebral and intervertebral levels where OPLL exits in the cervical spine. Axial classification comprises central and lateral lesions identified on axial CT images. Seven observers evaluated CT images using this classification system, and intra- and interrater reliability were examined. Results: Averaged Fleiss' kappa coefficient of interrater agreement was 0.43 ± 0.26 among the seven observers, averaged intrarater reliability for the existence of OPLL was 72.4 ± 8.8 {\%} [95 {\%} confidence interval (CI) 67.5-76.8]. Fifty-four patients (37.5 {\%}) had the bridge type and 90 the nonbridge type according to Classification A; 102 (70.8 {\%}) had central and 42 (29.2 {\%}) lateral OPLL in the axial classification. Four representative cases defined according to the three classification types are reported here. Conclusion: Subcommittee members of the Investigation Committee on the Ossification of the Spinal Ligaments of the Japanese Ministry of Public Health and Welfare propose three new classification systems of cervical OPLL based on CT imaging: A, B, and axial.",
author = "Yoshiharu Kawaguchi and Morio Matsumoto and Motoki Iwasaki and Tomohiro Izumi and Atsushi Okawa and Shunji Matsunaga and Kazuhiro Chiba and Takashi Tsuji and Masashi Yamazaki and Takahito Fujimori and Toshitaka Yoshii and Yoshiaki Toyama",
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Kawaguchi, Y, Matsumoto, M, Iwasaki, M, Izumi, T, Okawa, A, Matsunaga, S, Chiba, K, Tsuji, T, Yamazaki, M, Fujimori, T, Yoshii, T & Toyama, Y 2014, 'New classification system for ossification of the posterior longitudinal ligament using CT images', Journal of Orthopaedic Science, vol. 19, no. 4, pp. 530-536. https://doi.org/10.1007/s00776-014-0577-4

New classification system for ossification of the posterior longitudinal ligament using CT images. / Kawaguchi, Yoshiharu; Matsumoto, Morio; Iwasaki, Motoki; Izumi, Tomohiro; Okawa, Atsushi; Matsunaga, Shunji; Chiba, Kazuhiro; Tsuji, Takashi; Yamazaki, Masashi; Fujimori, Takahito; Yoshii, Toshitaka; Toyama, Yoshiaki.

In: Journal of Orthopaedic Science, Vol. 19, No. 4, 01.01.2014, p. 530-536.

Research output: Contribution to journalArticle

TY - JOUR

T1 - New classification system for ossification of the posterior longitudinal ligament using CT images

AU - Kawaguchi, Yoshiharu

AU - Matsumoto, Morio

AU - Iwasaki, Motoki

AU - Izumi, Tomohiro

AU - Okawa, Atsushi

AU - Matsunaga, Shunji

AU - Chiba, Kazuhiro

AU - Tsuji, Takashi

AU - Yamazaki, Masashi

AU - Fujimori, Takahito

AU - Yoshii, Toshitaka

AU - Toyama, Yoshiaki

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Ossification of the posterior longitudinal ligament (OPLL) is most frequently seen in the cervical spine. The types of cervical OPLL are classified into continuous, mixed, segmental, and other based on plain lateral X-ray. Computed tomography (CT) imaging is often used in clinical practice for evaluating ossified lesions as it can detect their precise location, size, and shape. However, to date, no CT classification of OPLL lesions has been proposed. Methods: One hundred and forty-four patients diagnosed with cervical OPLL by plain radiograph were included in this study. Sagittal and axial CT images of the cervical spine were obtained. We propose three classification systems: A, B, and axial. Classification A comprises two lesion types: bridge and nonbridge. Classification B requires examiners to describe all vertebral and intervertebral levels where OPLL exits in the cervical spine. Axial classification comprises central and lateral lesions identified on axial CT images. Seven observers evaluated CT images using this classification system, and intra- and interrater reliability were examined. Results: Averaged Fleiss' kappa coefficient of interrater agreement was 0.43 ± 0.26 among the seven observers, averaged intrarater reliability for the existence of OPLL was 72.4 ± 8.8 % [95 % confidence interval (CI) 67.5-76.8]. Fifty-four patients (37.5 %) had the bridge type and 90 the nonbridge type according to Classification A; 102 (70.8 %) had central and 42 (29.2 %) lateral OPLL in the axial classification. Four representative cases defined according to the three classification types are reported here. Conclusion: Subcommittee members of the Investigation Committee on the Ossification of the Spinal Ligaments of the Japanese Ministry of Public Health and Welfare propose three new classification systems of cervical OPLL based on CT imaging: A, B, and axial.

AB - Background: Ossification of the posterior longitudinal ligament (OPLL) is most frequently seen in the cervical spine. The types of cervical OPLL are classified into continuous, mixed, segmental, and other based on plain lateral X-ray. Computed tomography (CT) imaging is often used in clinical practice for evaluating ossified lesions as it can detect their precise location, size, and shape. However, to date, no CT classification of OPLL lesions has been proposed. Methods: One hundred and forty-four patients diagnosed with cervical OPLL by plain radiograph were included in this study. Sagittal and axial CT images of the cervical spine were obtained. We propose three classification systems: A, B, and axial. Classification A comprises two lesion types: bridge and nonbridge. Classification B requires examiners to describe all vertebral and intervertebral levels where OPLL exits in the cervical spine. Axial classification comprises central and lateral lesions identified on axial CT images. Seven observers evaluated CT images using this classification system, and intra- and interrater reliability were examined. Results: Averaged Fleiss' kappa coefficient of interrater agreement was 0.43 ± 0.26 among the seven observers, averaged intrarater reliability for the existence of OPLL was 72.4 ± 8.8 % [95 % confidence interval (CI) 67.5-76.8]. Fifty-four patients (37.5 %) had the bridge type and 90 the nonbridge type according to Classification A; 102 (70.8 %) had central and 42 (29.2 %) lateral OPLL in the axial classification. Four representative cases defined according to the three classification types are reported here. Conclusion: Subcommittee members of the Investigation Committee on the Ossification of the Spinal Ligaments of the Japanese Ministry of Public Health and Welfare propose three new classification systems of cervical OPLL based on CT imaging: A, B, and axial.

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