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 1) 2)
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 3).
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 4).
Anterior and posterior combined surgery may be another surgical option 5) 6).
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 7).