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

Abstract

Although ADF is technically demanding and has a higher incidence of surgery-related complications, it is preferable to laminoplasty for patients with occupying ratio of OPLL > or =60%.

Static versus dynamic factors for the development of myelopathy in patients with cervical ossification of the posterior longitudinal ligament

“…2,4 Iwasaki et al reported that the surgical outcome after laminoplasty was insufficient in patients with an OPLL occupation ratio >60% and hill-shaped ossification. 1 Tani et al reported that anterior decompression surgery was superior to laminoplasty in cervical OPLL patients when their occupation ratio was more than 50%.…”

“…2,4 Iwasaki et al reported that the surgical outcome after laminoplasty was insufficient in patients with an OPLL occupation ratio >60% and hill-shaped ossification. 1 Tani et al reported that anterior decompression surgery was superior to laminoplasty in cervical OPLL patients when their occupation ratio was more than 50%. 4 Recent reports have described the importance of dynamic factors, including mobility of the spinal column, in the development of myelopathy in patients who have a considerable degree of canal occupation by OPLL.…”

“…[1][2][3] Both anterior and posterior surgical approaches have been performed for cervical myelopathy due to OPLL, 1,2,4,5 and several studies have shown that the anterior surgical approach results in a better surgical outcome when the occupation ratio by OPLL is large, 2,4 indicating that complete removal of the static compression factor is important in the treatment of myelopathy.…”

Anterior Surgical Treatment of Cervical Spondylotic Myelopathy

“…In a series of patients with CSM due to OPLL, Iwasaki et al [25] described two shapes of anterior compressive pathoanatomy: (a) hillshaped lesions and (b) broad-based or flat lesions. In their study, Iwasaki et al found that hill-shaped lesions responded better to ventral decompression techniques whereas flat or generalized stenosis patients did as well or better with dorsal procedures such as laminoplasty [74,21,25].…”

“…In patients with primarily disc space pathology, anterior cervical discectomy will allow for adequate decompression; however, in patients with significant retrovertebral compression, an extruded migrated disc fragment, or ossification of the posterior longitudinal ligament (OPLL), corpectomy may be necessary [43]. In a series of patients with CSM due to OPLL, Iwasaki et al [25] described two shapes of anterior compressive pathoanatomy: (a) hillshaped lesions and (b) broad-based or flat lesions. In their study, Iwasaki et al found that hill-shaped lesions responded better to ventral decompression techniques whereas flat or generalized stenosis patients did as well or better with dorsal procedures such as laminoplasty [74,21,25].…”