Association between ossification of the nuchal ligament and cervical imaging changes
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Changshuo Hu1,2, Can Cao2, Shangju Gao2
1Hebei Medical University, Shijiazhuang, China.
Purpose:
This study aimed to investigate the association between ossification of the nuchal ligament (ONL) and cervical imaging changes in patients with cervical spondylosis.
Methods:
The study population consisted of 203 patients with cervical spondylosis from January 2023 to October 2025. All patients underwent cervical X-ray, CT, and MRI. Demographic, clinical, and imaging data were collected and analyzed. On cervical MRI, the total scores for cervical disc degeneration (TSCDD) and vertebral bone quality (VBQ) scores were used to evaluate the overall severity of degeneration of the cervical spine. Logistic regression analysis was used to identify factors associated with ossification of the nuchal ligament (ONL).
Results:
The study population included 108 patients with ONL and 95 patients without it. Patients in the ONL group were older than those without ONL (P < 0.001), they had a longer symptom duration (P = 0.006), a higher proportion of cervical spondylotic myelopathy (P = 0.039), and were more likely to have concomitant HBP (P < 0.001) and OPLL (P < 0.001). The cervical intervertebral disc height loss scores in the ONL group were higher than those in the non-ONL group (P = 0.001). In addition, the total scores for cervical disc degeneration (TSCDD) for intervertebral disc degeneration and the VBQ scores were also higher in the ONL group (P < 0.001). Spearman correlation analysis indicated that age, types of cervical spondylosis, duration, hypertension, OPLL, cervical intervertebral disc height loss scores, TSCDD and the VBQ scores were positively associated with the presence of ONL (P < 0.05), but the correlations were from weak to mild. Logistic regression analysis indicated that TSCDD (OR = 1.179, 95% CI = 1.064-1.306), VBQ scores (OR = 2.152, 95% CI = 1.286-3.599), HBP (OR = 2.041, 95% CI = 1.075-3.877), and OPLL (OR = 3.151, 95% CI = 1.539-6.452) were independently associated with the presence of ONL (all P < 0.05).
Conclusion:
The presence of ONL in patients with cervical spondylosis is associated with several parameters, including HBP, OPLL, TSCDD, and VBQ scores. The overall severity of cervical disc degeneration and VBQ scores in the ONL group were higher than those in the non-ONL group.
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