Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

Abstract

Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.

Single-Stage Posterior Approach for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament With K-line (−) Using Thick Cervical Pedicle Screw System: A Technical Note and Preliminary Results

“…2,16,17 In our study, 2 patients reported axial pain, which was effectively alleviated at 6 months postoperatively, similar to that noted in previous reports. 2,17 C5 palsy, another common complication of cervical laminoplasty, with incidence rates between 0% and 13.6%, may develop due to posterior decompression, leading to spinal cord shifting with resultant traction on the spinal cord and/or nerve roots. 18 In the present study, one patient who underwent hybrid decompression procedures and foraminotomy, with improvement of C2-C7 angle from À17.0 to 5 , had C5 palsy that was resolved at 9 postoperative months through rehabilitation.…”

Ossification of the Posterior Longitudinal Ligament in the Cervical, Thoracic, and Lumbar Spine

“…Surgical intervention has demonstrated considerable efficacy in improving clinical outcomes for patients with myelopathy as a result of cervical or thoracolumbar OPLL [ 6 , 14 ]. The degree of myelopathy, determined by clinical symptom severity, is associated with the potential benefit of surgery with severe cases showing benefit from surgery, while medical management offers the same benefit as surgery for those with minimal symptoms [ 6 , 15 ]. For those treated conservatively, however, the risk for significant spinal cord injury causing significant disability remains markedly elevated [ 6 , 16 ].…”

“…The degree of myelopathy, determined by clinical symptom severity, is associated with the potential benefit of surgery with severe cases showing benefit from surgery, while medical management offers the same benefit as surgery for those with minimal symptoms [ 6 , 15 ]. For those treated conservatively, however, the risk for significant spinal cord injury causing significant disability remains markedly elevated [ 6 , 16 ]. Reported surgical applications for OPLL aim to decompress the spinal cord and subsequently stabilize the spinal column via different approaches including anterior cervical discectomy and fusion, posterior laminectomy and fusion, posterior laminoplasty, and circumferential approaches such as posterior circumferential decompression [ 6 , 7 , 14 , 17 ].…”

“…The surgical treatment of cervical OPLL is a subject of debate among experts and is largely approached on an individual basis based upon the symptoms or risk of severe spinal cord injury, risks of surgical intervention, and patient-specific considerations [ 5 , 6 ]. Treatment is further complicated by the increased risk of certain diseases highly associated with OPLL such as idiopathic skeletal hyperostosis and ankylosing spondylitis, and the relatively high incidence of concomitant thoracolumbar OPLL involvement [ 6 , 7 ]. The literature is markedly limited in discussing the appropriate surgical and medical management of complicated presentations of OPLL involving multiple sites along the spinal cord.…”

Comparison of Anterior and Posterior Decompressions in Treatment of Traumatic Thoracolumbar Spinal Fractures Complicated with Spinal Cord Injury

“…Thoracolumbar spinal fractures complicated with spinal cord injury serverely negatively impact the quality of life of patients [ 8 , 9 ]. The T 11 –L 2 spine segment is the intersection of physiological curvature of the thoracic and lumbar vertebrae, with concentrated stress, a small range of motion, and a narrow spinal canal, which has a high risk of spinal cord and/or cauda equina injury after fractures [ 10 ]. Spinal cord and cauda equina injuries result in limb sensory and motor dysfunction or even paralysis [ 11 ].…”