Anterior longitudinal ligament ossification

　　In addition to idiopathic anterior longitudinal ligament ossification of unknown etiology, the vast majority of cases are caused by degenerative changes between vertebral bodies, with excessive motion or trauma of the cervical and lumbar spine as secondary factors. Due to the degeneration of the vertebral bodies, the anterior longitudinal ligament becomes relaxed, leading to subligamentous hemorrhage and anterior displacement (or prolapse) of the nucleus pulposus. While osteophytes form in front of the vertebral bodies, the local ligament also calcifies and gradually ossifies. This pathological process may last for many years, eventually leading to a reduction in vertebral body mobility and even complete ossification, presenting as fusion.

　　Anterior longitudinal ligament ossification can lead to esophageal compressive cervical spondylosis. Esophageal compressive cervical spondylosis, also known as dysphagia type cervical spondylosis, is mainly caused by degeneration of intervertebral discs leading to tears, hemorrhage, calcification, and osteophyte formation in the anterior longitudinal ligament and subperiosteal area. These osteophytes vary in size, with medium and small ones being more common, and the sagittal diameter is usually less than 5mm. Clinically, they are relatively rare and may be misdiagnosed or missed.

　　Osteoarthritis of the anterior longitudinal ligament presents in the early stage with neck discomfort due to local facet joint reflex of the sinus nerve, limited flexibility, and mild local pain. Those with large osteophytes at the anterior margin of the vertebral body may experience swallowing difficulties and a foreign body sensation in the throat, and may develop esophageal compressive cervical spondylosis. However, in the lumbar region, the symptoms are usually mild or asymptomatic. Osteoarthritis of the anterior longitudinal ligament is rarely associated with positive signs, and those with extensive involvement may have mild to moderate limitation of cervical and lumbar mobility, mainly affecting extension and flexion functions.

　　The prevention of ossification of the anterior longitudinal ligament is particularly important, and the following two points should be noted:

　　1、Pay attention to protecting the neck or waist in daily life, avoid外伤 and overexertion.

　　2、Strengthen physical exercise, enhance physical fitness, reduce risk factors such as smoking and alcoholism, and improve immunity.

　　Imaging examinations are the main basis for the diagnosis of this disease, including the following three types.

　　1、X-ray film: On the lateral X-ray film, the anterior longitudinal ligament shows calcified (ossified) shadows, which can be single (solitary type) or multiple (scattered or diffuse type), with osteophytes, the image is particularly clear, most frequently at C4-5 and C5-6, followed by C3-4 and C6-7. The calcified (ossified) ligament is mostly in the form of strips, and can also be in the form of protuberances projecting forward.

　　2、Tomography and CT examination: Tomography and CT examination are of great significance for the diagnosis of this disease, especially in early cases.

　　3、MRI examination: Simple cases generally do not require MRI examination, but when it involves surrounding soft tissues, it is necessary to determine the extent of involvement.

　　General cases do not require special treatment, just pay attention to protecting the neck or waist, and avoid外伤 and overexertion. For those with local pain and other general symptoms, symptomatic treatment can be given. For patients with other diseases, the focus should be on treating lesions that affect the body's function, and for ossified anterior longitudinal ligaments, there is generally no need for special treatment. For those who have stimulation or compression on the esophagus, the ossified anterior longitudinal ligament can be surgically removed. For those with lumbar instability or lumbar intervertebral disc prolapse (protrusion), treatment can be carried out together (including surgical treatment).