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

Conclusions

Ossification of the PLL is a complex multifactorial disease process that requires an understanding of the etiology of the disease as well as the role for surgical intervention. Most patients who present with symptomatic OPLL will eventually require surgery. The natural history of OPLL is that of progressive neurological decline resulting from enlargement of the ossified ligament and resulting stenosis. Clinical myelopathy is further worsened by a dynamic process whereby mechanical stress is transferred into reactive inflammation. The role of surgery is to decompress and stabilize the spine. For patients who demonstrate appropriate lordosis, laminoplasty or laminectomy may be a viable option. However, studies suggest that despite preservation of cervical lordosis, patients with myelopathy secondary to OPLL require stabilization. The decision to use an anterior or posterior approach is left to the discretion of the surgeon. Both anterior and posterior approaches have been shown to be safe and effective in our experience. Due to the ability to create lordosis in the cervical spine, outcomes from anterior decompression and reconstruction have been shown in the literature to be superior to the posterior decompression and stabilization. We have demonstrated successful decompression and fusion from both an anterior and a posterior approach. The choice of which approach to use is based on a number of factors that influence patient outcomes.

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