Ossification of the Posterior Longitudinal Ligament

Pathogenesis, Management, and Current Surgical Approaches: A Review

Zachary A. Smith, M.D.; Colin C. Buchanan, M.D.; Dan Raphael, P.A.-C.; and Larry T. Khoo, M.D.

Disclosures

Neurosurg Focus. 2011;30(3):e10 

In This Article

Surgical Management of OPLL

Patients with OPLL commonly present with symptoms in their 40s or 50s. This commonly begins with symptoms of numbness or axial neck pain. Without surgical decompression, symptomatic OPLL tends to progress with time. In a long-term follow-up study, Matsunaga et al.[40] demonstrated that 38% of patients presenting with baseline myelopathy had progressive worsening of their symptoms. Ossification of the PLL has been additionally found to progress following decompression[27] as well as during routine radiographic follow-up in the patient in whom decompression has not been performed.[49] For these reasons, especially for younger patients without established deficits, it is our practice to obtain strict radiographic follow-up. In patients with progressive deficits, including severe weakness or myelopathy, surgery is considered. Like other authors, we believe that older patients with significant comorbid conditions and severe, longstanding deficits may be poor surgical candidates.[14,60]

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