Operative Results and Postoperative Progression of Ossification Among Patients With Ossification of Cervical Posterior Longitudinal Ligament

TLDR

Ossification of the cervical posterior longitudinal ligament (OPLL) is a recognized cause of severe cervical myelopathy or radiculopathy, though its pathogenesis remains unclear. The study seeks to identify biological, structural, and mobility-related factors that drive postoperative ossification progression in OPLL patients. The authors retrospectively followed 53 OPLL patients who underwent surgery for myelopathy or radiculopathy over a 16‑year period. About 70% of patients achieved recovery, while postoperative ossification progressed in 75% of continuous and mixed types but rarely in segmental and other types, prompting recommendations for anterior decompression in segmental and other types, posterior decompression in continuous and mixed types, and combined two-stage decompression for mixed types when necessary.

Abstract

Although the pathogenesis of ossification of the cervical posterior longitudinal ligament (OPLL) has not yet been clarified, it has come to be widely recognized that severe cervical myelopathy or radiculopathy is caused by OPLL. Fifty-three cases who were operated on for OPLL with myelopathy or radiculopathy in our clinic over the past 16 years were followed up. A recovery rate of approximately 70% was observed. Postoperative progressions of the ossification were observed among 75% of the cases of continuous and mixed type but seldom among those with segmental and other types. As causative factors for these postoperative progressions of the ossification, the authors would like to advocate biological, structural, and mobility-related elements. We concluded that in the ossified stage it is desirable to apply anterior decompression for the segmental and other type, posterior decompression for the continuous and mixed type, and, if necessary, two-stage combined decompression for the mixed type.