Surgical Treatment for Ossification of the Posterior Longitudinal Ligament in the Cervical Spine

Abstract

Although classically associated with patients of East Asian origin, ossification of the posterior longitudinal ligament (OPLL) may cause myelopathy in patients of any ethnic origin. Degeneration of the PLL is followed by endochondral ossification, resulting in spinal cord compression. Specific genetic polymorphisms and medical comorbidities have been implicated in the development of OPLL. Patients should be evaluated with a full history and neurologic examination, along with cervical radiographs. Advanced imaging with CT and MRI allows three-dimensional evaluation of OPLL. Minimally symptomatic patients can be treated nonsurgically, but patients with myelopathy or severe stenosis are best treated with surgical decompression. OPLL can be treated via an anterior (ie, corpectomy and fusion) or posterior (ie, laminectomy and fusion or laminoplasty) approach, or both. The optimal approach is dictated by the classification and extent of OPLL, cervical spine sagittal alignment, severity of stenosis, and history of previous surgery. Anterior surgery is associated with superior outcomes when OPLL occupies >50% to 60% of the canal, despite increased technical difficulty and higher complication rates. Posterior surgery is technically easier and allows decompression of the entire cervical spine, but patients may experience late deterioration because of disease progression.

A novel technique to correct kyphosis in cervical myelopathy due to continuous-type ossification of the posterior longitudinal ligament

“…9,12 However, for anterior surgery in patients with OPLL, it has been reported that this approach is technically demanding and associated with a higher incidence of operation-related complications. 1,9 These complications included the risk of a dural tear or CSF leakage, which was difficult to repair in anterior cervical surgery. 2,13 The incidence of dural tear and CSF leakage has been reported to be 13.7-fold greater in patients with OPLL compared with patients affected by other conditions.…”

“…1,3 Although the selection of an anterior or posterior approach has been the subject of debate, multilevel cord compression by OPLL and preoperative lordotic sagittal alignment are conditions that favor a posterior approach. 11 However, many studies have shown that poor clinical and radiological outcomes may occur if posterior laminoplasty or laminectomy is performed in patients with cervical kyphosis.…”

Degenerative Cervical Myelopathy

“…As spinal cord compromise is caused by various lesions in DCM, compression may occur anteriorly (disc, osteophyte, or OPLL), posteriorly (hypertrophy or ossification of ligamentum flavum), and the concept of decompression performed from the side of major compressive factors seems to be straightforward and well accepted. For example, it may be that superior outcomes result from anterior decompression for OPLL with more than 60 % of canal occupying ratio [9][10][11][12]. However, DCM can frequently be associated with multiple degenerative lesions and compression can be circumferential.…”

Addition of instrumented fusion after posterior decompression surgery suppresses thickening of ossification of the posterior longitudinal ligament of the cervical spine

“…Laminoplasty (LMP) is a widely accepted surgical procedure for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine [1][2][3][4]. Thickening of OPLL can occur in the long term after LMP, possibly resulting in recurrence of spinal cord compression and deterioration of neurological symptoms [5,6].…”