Surgical Strategy for Cervical Myelopathy due to Ossification of the Posterior Longitudinal Ligament

Abstract

Laminoplasty is effective and safe for most patients with occupying ratio of OPLL less than 60% and plateau-shaped ossification. However, neurologic outcome of laminoplasty for cervical OPLL was poor or fair in patients with occupying ratio greater than 60% and/or hill-shaped ossification.

Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine

“…Limitation of laminoplasty may become more significant in patients with cervical kyphotic deformity. In addition, progressive kyphosis and progression of OPLL after laminoplasty may cause neurological deterioration in the long-term follow-up [9]. Therefore, this study focussed on the questions of when to choose anterior decompression for severe OPLL and how to remove the ossified lesions.…”

“…The difficulties for an anterior approach lie not only in resection of OPLL but also in restoration of bone defect after corpectomy. Iliac crest struts could be grafted for two-level corpectomy and a technique of fibula grafting was used for three-or more level corpectomy [4,10,19]. However, the traditional autologous bone graft was reported to have a high incidence of donor site complications, including subcutaneous haematoma, wound infection, and chronic wound pain.…”

“…In particular, if OPLL is associated with dural ossification (DO), which is reported to be more common in the cases of severe OPLL, the risk of unexpected complications including cerebrospinal fluid leakage and iatrogenic neurological deterioration significantly increases [1,5,6,8]. Although the superiority of the anterior approach has been reported in several studies, the surgical strategy for severe OPLL still remains controversial [10,14,19]. Starting in 2002, anterior corpectomy and fusion was performed for select patients with severe OPLL in our department.…”

Expert’s comment concerning Grand Rounds case entitled “Management of cervical myelopathy due to ossification of posterior longitudinal ligament in a patient with Alström syndrome” (by Bronek M. Boszczyk, Rishi Mugesh Kanna and Daniela Gradil)

“…Anterior corpectomy has the advantage of thorough decompression with removal of the ossified mass, which promises a better long-term result [3]. The major shortcoming of anterior approach (AA) is that it is not appropriate for very extensive lesion and that the fusion rate drops in that condition.…”

“…Posterior approach (PA) is preferred by some surgeons for safety and ease, but it could not provide adequate decompression of spinal cord in patients with preoperative kyphosis, and the results were not as good as AA, especially in massive ossification and in long follow-up. Mean improvement rate after operation W. Yuan (&) Department of Orthopedics, Changzheng Hospital, Secondary Military Medical University, Fengyang Road 415, Shanghai, China e-mail: yuanwenspine@163.com was 58-68.4 % in AA and 13-54 % in PA, and fell to 34 and 14 % during follow-up [3][4][5].…”