Biomechanical effects of spinal cord compression due to ossification of posterior longitudinal ligament and ligamentum flavum: A finite element analysis

Ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) have been recognized as causes of myelopathy due to thickening of the ligaments resulting in narrowing of the spinal canal and compression of the spinal cord. However, few studies have focused on predicting stress distribution under conditions of OPLL and OLF based on clinical aspects such as the relationship between level of stress and severity of neurologic symptoms because direct in vivo measurement of stress is very restrictive. In this study, a three-dimensional finite element model of the spinal cord in T12-L1 was developed based on MR images. The von-Mises stresses in the cord and the cross-sectional area of the cord were investigated for various grades and shapes of spinal cord compression in OPLL and OLF. Substantial increases in maximum stresses resulting in the manifestation of spinal cord symptoms occurred when the cross-sectional area was reduced by 30–40% at 60% compression of the antero-posterior diameter of the cord in OPLL and at 4 mm compression in OLF. These results indicate that compression greater than these thresholds may induce spinal symptoms, which is consistent with clinical observations.