Influence of sagittal and axial types of ossification of posterior longitudinal ligament on mechanical stress in cervical spinal cord: A finite element analysis

• The effect of sagittal and axial ossification of posterior longitudinal ligament types on the spinal cord was predicted.
• Cross-sectional area and volume of the cord and stress in the cord were investigated.
• The influence of axial type was less than that of sagittal type.
• A higher level of sagittal extension would increase the peak cord tissue stress.
• Central type showed higher maximum stresses in the cord than lateral deviated type.

BackgroundThere are few studies focusing on the prediction of stress distribution according to the types of ossification of the posterior longitudinal ligament, which can be fundamental information associated with clinical aspects such as the relationship between stress level and neurological symptom severity. In this study, the influence of sagittal and axial types of ossification of the posterior longitudinal ligament on mechanical stress in the cervical spinal cord was investigated.MethodsA three-dimensional finite element model of the cervical spine with spinal cord was developed and validated. The von Mises stresses in the cord and the reduction in cross-sectional areas and volume of the cord were investigated for various axial and sagittal types according to the occupying ratio of ossification of the posterior longitudinal ligament in the spinal canal.FindingsThe influence of axial type was less than that of the sagittal type, even though the central type showed higher maximum stresses in the cord, especially for the continuous type. With a 60% occupying ratio of ossification of the posterior longitudinal ligament, the maximum stress was significantly high and the cross-sectional area of the spinal cord was reduced by more than 30% of the intact area regardless of sagittal or axial types. Finally, a higher level of sagittal extension would increase the peak cord tissue stress, which would be related to the neurological dysfunction and tissue damage.InterpretationQuantitative investigation of biomechanical characteristics such as mechanical stress may provide fundamental information for pre-operative planning of treatment for ossification of the posterior longitudinal ligament.