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LETTER TO EDITOR
Year : 2006  |  Volume : 54  |  Issue : 4  |  Page : 448-450

Ossification of the posterior longitudinal ligament of the thoracic spine in association with polycystic ovary syndrome


Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan

Correspondence Address:
Shunji Matsunaga
Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.28135

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How to cite this article:
Imamura K, Matsunaga S, Nagata M, Nakamura K, Yokouchi M, Yamamoto T, Hayashi K, Komiya S. Ossification of the posterior longitudinal ligament of the thoracic spine in association with polycystic ovary syndrome. Neurol India 2006;54:448-50

How to cite this URL:
Imamura K, Matsunaga S, Nagata M, Nakamura K, Yokouchi M, Yamamoto T, Hayashi K, Komiya S. Ossification of the posterior longitudinal ligament of the thoracic spine in association with polycystic ovary syndrome. Neurol India [serial online] 2006 [cited 2019 Dec 13];54:448-50. Available from: http://www.neurologyindia.com/text.asp?2006/54/4/448/28135


Sir,

A 24-year-old woman visited our hospital with a three-week history of muscle weakness and sensory disturbance of bilateral lower extremities. She exhibited moon-face, hepertrichosis, obesity and hyperglycemia, which are findings typical of Cushing's syndrome. However, this patient did not have a pituitary tumor. Tomography of the thoracic spine revealed ossification of the posterior longitudinal ligament (OPLL) at levels T6 to T9 [Figure - 1] and severe compression of the spinal cord was found on magnetic resonance imaging [Figure - 2]. Myelography and computer tomography were performed and OPLL was recognized at levels T3 to T9 of the spine [Figure - 3]. She was diagnosed with thoracic myelopathy due to OPLL. Hypercholesterolemia and abnormally high testosterone level were found. She had also polycystic lesions in both ovaries [Figure - 4] on magnetic resonance imaging and the diagnosis of polycystic ovary syndrome was established. Her neurological symptoms aggravated rapidly and she developed paraplegia. Emergency T3 to T9 laminectomy was performed [Figure - 5] and her neurological symptoms were improved by surgery and she began to walk by eight weeks after surgery.

The patient presented here also had obesity and other abnormalities including hyperinsulinemia and hyperandrogenemia. Hyperinsulinemia has been reported as a factor possibly related to the occurrence of OPLL.[1] Polycystic ovary syndrome is characterized by polycystic lesions of both ovaries, oligoovulation, obesity, virilism, insulin resistance compensatory hyperinsulinemia and hyperandrogenemia.[2] The prevalence rates of polycystic ovary syndrome for Black and White women were reported to be 8.0 and 4.8%.[3] Our survey revealed no paper reporting the occurrence of OPLL in patients with polycystic ovary syndrome. However, the patients with polycystic ovary syndrome had been treated by gynecologists and the survey of the spine was not performed. The OPLL association with polycystic ovary syndrome might not be accidental. The characteristic findings of obesity, insulin resistance compensatory hyperinsulinemia, increased levels of free insulin-like growth factor-I (IGF-I)[4] and hyperandrogenemia in patients with polycystic ovary syndrome are suspected to be related to the occurrence of OPLL. The stature of female patients with OPLL in the thoracic spine corresponds to patients with polycystic ovary syndrome. IGF-I was reported to be involved in the development of OPLL.[5] Hormonal surveys for patients with OPLL in the thoracic spine may be useful for clarifying the pathogenesis of OPLL.

 
  References Top

1.Akune T, Ogata N, Seichi A, Ohnishi I, Nakamura K, Kawaguchi H. Insulin secretary response is positively associated with the extent of ossification of the posterior longitudinal ligament of the spine. J Bone Joint Surg Am 2001;83:1537-44.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Lobo RA. What are the key features of importance in polycystic ovary syndrome? Fertil Steril 2003;80:259-61.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in unselected population. J Clin Endocrinol Metab 2004;89:2745-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Iwashita M, Mimuro T, Watanabe M, Setoyama T, Matsuo A, Adachi T, et al . Plasma levels of insulin-like growth factor-I and its binding protein in polycystic ovary syndrome. Horm Res 1990;33:21-6.  Back to cited text no. 4    
5.Goto K, Yamazaki M, Goto S, Kon T, Moriya H, Fujimura S. Involvement of insulin-like growth factor I in development of ossification of the posterior longitudinal ligament of the spine. Calcif Tissue Int 1998;62:158-65.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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Modern Rheumatology. 2008; 18(3): 277
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2 Ossification of the posterior longitudinal ligament in dizygotic twins with schizophrenia: a case report
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