Ossification of the posterior longitudinal ligament in vitamin D-resistant rickets: case report and review of the literature.
METHODS
A case report of cervical myelopathy caused by ossification of the posterior longitudinal ligament in a patient with vitamin D-resistant rickets is presented together with a review of literature.


OBJECTIVE
To report the diagnosis of ossification of the posterior longitudinal ligament in a white woman with vitamin D-resistant rickets.


BACKGROUND
The association between ossification of the posterior longitudinal ligament and untreated vitamin D-resistant rickets has been reported in Japan, but infrequently in white populations. In whites, ossification of the posterior longitudinal ligament is closely associated with diffuse idiopathic skeletal hyperostosis. A clear association between ossification of the posterior longitudinal ligament and vitamin D-resistant rickets in white populations has not yet been established.


METHODS
The medical record and imaging studies of a patient treated at the authors' institution for cervical myelopathy caused by ossification of the posterior longitudinal ligament in the setting of treated vitamin D-resistant rickets were reviewed. A Medline search of the medical literature between 1966-1999 was performed to identify pertinent studies and similar case reports.


RESULTS
The occurrence of spinal stenosis in untreated adults with vitamin D-resistant rickets has been reported in all regions of the spine in Japanese patients. The association between ossification of the posterior longitudinal ligament and untreated vitamin D-resistant rickets was first reported in Japan, where ossification of the posterior longitudinal ligament is endemic. This association may be incidental, because reports on ossification of the posterior longitudinal ligament in whites are not as frequent as in Japanese, reflecting the higher prevalence of this condition in Japan.


CONCLUSIONS
Ossification of the posterior longitudinal ligament and ossification of the posterior longitudinal ligament associated with deranged calcium or phosphate metabolism may be different pathologic entities sharing a common outcome. Adequate treatment of vitamin D-resistant rickets may not always prevent or reverse ossification of the posterior longitudinal ligament.
Department of Orthopedic Surgery and the Division of Endocrinology, Metabolism, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
G J
GJ
Velan
B L
BL
Currier
B L
BL
Clarke
M J
MJ
Yaszemski
D015519:Bone Density; D002118:Calcium / Q000097:blood; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007015:Hypophosphatemia, Familial / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D010710:Phosphates / Q000097:blood; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014807:Vitamin D / Q000627:therapeutic use
D010710:Phosphates; D014807:Vitamin D; D002118:Calcium