Surgical Management of Ossification of the Posterior Longitudinal Ligament

Abstract

Ossification of the posterior longitudinal ligament (OPLL) in the cervical region is now regarded as a curable disease. However, the selection of surgical procedure, whether it should be by anterior approach or posterior approach, is still controversial. The purpose of this paper is twofold : (I) to describe our selection of treatment for cervical OPLL in our institute ; and (II) to evaluate results of two major surgical procedures ; i.e., anterior decompression with inter-body fusion and posterior decompression. The series consisted of 169 patients who were surgically treated. Their age ranged from 24 to 76 years with a mean of 55.4 years. Anterior approach was performed in 132 patients, and posterior decompression was carried out in 37 patients. We mainly use the anterior approach because it can extirpate the ossified lesion itself. The indication for choosing posterior decompression is as follows : (1) extensive OPLL longer than 4 vertebral bodies, (2) non-localized spinal cord compression, (3) narrow spinal canal. Postoperative results were satisfactory in both groups. It is essential to decide the most suitable method of treatment, whether anterior or posterior decompression, for cervical OPLL patients.