Surgical Management of Cervical Ossification of the Posterior Longitudinal Ligament: Natural History and the Role of Surgical Decompression and Stabilization

Patrick A. Sugrue, M.D.; Jamal McClendon Jr., M.D.; Ryan J. Halpin, M.D.; John C. Liu, M.D.; Tyler R. Koski, M.D.; Aruna Ganju, M.D.

Disclosures

Neurosurg Focus. 2011;30(3):e3 

In This Article

Surgical Management

Nonoperative management of OPLL is reserved for patients who have few neurological symptoms or for those whose overall medical health precludes them from surgical treatment. Pharmacological pain management with the guidance of multidisciplinary pain specialists is recommended. Nonsteroidal antiinflammatory medications and steroid injections are the mainstays of nonoperative therapy. Unfortunately, despite the inflammatory nature of the disease, there have been few pharmacological advances in the specific antiinflammatory agents designed for OPLL, as compared with other inflammatory disease such as rheumatoid arthritis or ankylosing spondylitis.

Nearly 70% of cases of OPLL involve the cervical spine.[5] Most patients with cervical OPLL come to the attention of spine surgeons because of clinical findings of myelopathy, radiculopathy, or both and thus require surgical intervention. The questions that often face the surgeon involve the appropriate surgical approach: anterior versus posterior and decompression alone versus decompression and stabilization. The location of the OPLL, in conjunction with the patient's clinical symptoms, guides the surgeon in formulating a surgical plan. There are different treatment options available for OPLL of the cervical spine, compared with OPLL of the thoracic or lumbar spine. In the cervical spine, the anterior spinal column is much more accessible and often carries less morbidity than the thoracotomy that would be required for anterior access to the thoracic spine. Many patients with OPLL harbor other medical comorbidities or are of advanced age such that thoracotomy is not an ideal choice. On the other hand, older patients undergoing multilevel cervical corpectomy have been shown to have an increased rate of significant dysphagia postoperatively. Posterior decompression via laminectomy or laminoplasty is an option at any level of the spine. The need for stabilization is often greater in the cervical spine than in the thoracic spine, the latter being supported by the thoracic cage. However, kyphosis of the thoracic spine may increase the need for instrumented stabilization to minimize the risk of a progressive kyphotic deformity in the setting of a disrupted posterior tension band. There are many factors that influence the surgical plan for OPLL, and in this manuscript we analyze our single-institution experience with surgically treated cervical OPLL.

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