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

Methods

After obtaining institutional review board approval, we retrospectively analyzed our own patient experience with cervical OPLL. Individual surgeon case logs and billing records were reviewed for the previous 10 years (2000–2010). We retrospectively identified 18 patients (Table 1) who underwent surgery for symptomatic cervical myelopathy secondary to radiographically confirmed OPLL. The different types of OPLL as classified by Hirabayashi et al.[10] were evenly distributed among our patients: continuous in 6, segmental in 6, and mixed in 6. Twelve patients underwent laminectomy and instrumented stabilization (Figs. 1 and 2), 3 patients underwent 2-level corpectomy, 2 patients underwent 1-level corpectomy (Figs. 3 and 4), and 1 patient underwent 1-level corpectomy with adjacent-level anterior cervical discectomy and fusion. Medical record chart review was performed to obtain both preoperative and postoperative neurological examination status as well as presenting complaints. The type of procedure was recorded as well as findings of pre- and postoperative neurological examinations and follow-up imaging. Any intraoperative or postoperative complications documented in the medical record were also recorded. The average follow-up time was calculated. Any change in neurological examination findings documented in the medical record was recorded.

Figure 1.

Case 5. Preoperative images. This 59-year-old woman was found to have cervical spondylitic myelopathy and OPLL. A: Sagittal CT reconstruction demonstrating continuous OPLL at the C4–6 levels. B and C: Axial CT images revealing severe spinal canal stenosis due to OPLL at multiple levels. There is also evidence of DISH on the sagittal and axial images.

Figure 2.

Case 5. Postoperative images. Anterior-posterior (left) and lateral (right) radiographs obtained after C3–7 laminectomy and C3–T2 instrumented posterior spinal fusion.

Figure 3.

Case 4. Preoperative images. This 79-year-old man with gait difficulties was found to have cervical spondylitic myelopathy secondary to continuous OPLL as seen on sagittal T2-weighted MR imaging (A), sagittal CT reconstruction (B), and axial CT (C).

Figure 4.

Case 4. Postoperative images. Anterior-posterior (left) and lateral (right) radiographs obtained after C-5 corpectomy and C4–6 anterior spinal fusion.

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