====== Cervical ossification of the posterior longitudinal ligament surgery ======

Determining the optimal surgical method for cervical OPLL is not straightforward. Anterior resection for
OPLL with or without wide corpectomy and anterior fusion may provide a useful option 
((Abe H, Tsuru M, Ito T, et al. Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg 1981;55:108-16.))
((Kojima T, Waga S, Kubo Y, et al. Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament. Neurosurgery 1989;24:864-72.))

There are multiple options ranging from observation to many kinds of surgical procedures, including posterior laminoplasty, laminectomy with or without fusion, anterior corpectomy with or without instrumentation, and circumferential decompression and fusion. None of these surgical approaches is free of complications. However, to date, there is still a lack of consensus regarding the choice of the surgical approach and the timing of surgical intervention. [[Cervical spinal cord injury]] and related neurological disabilities are more likely to occur in OPLL patients, who should therefore be cautioned regarding the possibility of a subsequent SCI if treated without surgery
((Wu JC, Chen YC, Huang WC. Ossification of the Posterior Longitudinal Ligament 
in Cervical Spine: Prevalence, Management, and Prognosis. Neurospine. 2018
Mar;15(1):33-41. doi: 10.14245/ns.1836084.042. Epub 2018 Mar 28. Review. PubMed
PMID: 29656627.
)).

Anterior [[cervical spine decompression]] and [[reconstruction]] is a safe and appropriate treatment for [[cervical  myelopathy]] in the setting of single or two level OPLL. [[Cervical laminectomy]] or laminoplasty is indicated in patients with preserved cervical lordosis having three or more levels of involvement. Younger patients with good pre operative functional status and less than 2 levels of involvement have better outcome following anterior surgery
((Kommu R, Sahu BP, Purohit AK. Surgical outcome in patients with cervical
ossified posterior longitudinal ligament: A single institutional experience.
Asian J Neurosurg. 2014 Oct-Dec;9(4):196-202. doi: 10.4103/1793-5482.146602.
PubMed PMID: 25685216; PubMed Central PMCID: PMC4323963.)).

Anterior and posterior combined surgery may be another surgical option 
((Lee SH, Kim KT, Lee JH, et al. 540° Cervical realignment
procedure for extensive cervical OPLL with kyphotic deformity. Spine (Phila Pa 1976) 2016;41:1876-83.))
((Arima H, Naito K, Yamagata T, et al. Anterior and posterior
segmental decompression and fusion for severely localized
ossification of the posterior longitudinal ligament of the cervical spine: technical note. Neurol Med Chir (Tokyo) 2019;59:238-45.)).

Various radiological parameters are used to evaluate [[cervical ossification of the posterior longitudinal ligament]] and to determine the surgical strategy.
Factors such as the number of involved spinal segments, [[cervical alignment]] or [[T1 slope]], the relationship between OPLL and the [[C2–7 line]] (termed the “[[K-line]]”), occupying ratio of OPLL, and involvement of dural ossification need to be carefully considered before surgery
((Shimokawa N, Sato H, Matsumoto H, Takami T. Review of Radiological Parameters,
Imaging Characteristics, and Their Effect on Optimal Treatment Approaches and
Surgical Outcomes for Cervical Ossification of the Posterior Longitudinal
Ligament. Neurospine. 2019 Sep;16(3):506-516. doi: 10.14245/ns.1938268.134. Epub 
2019 Sep 30. PubMed PMID: 31607082; PubMed Central PMCID: PMC6790724.
)).


===== Complications =====

[[Cervical ossification of the posterior longitudinal ligament surgery complications]].