Surgical Technique and Results of Anterior Decompression and Fusion for Ossification of Cervical Posterior Longitudinal Ligament

Norihiko Tamaki, MD
Tatsuya Nagashima MD (Kobe, Japan)

In the most cases of cervical myelopathy due to ossification of cervical posterior longitudinal ligament (OPLL), anterior decompression and fusion are indicated. We present the favorable results of anterior decompression and fusion for cervical OPLL.

Materials and Methods:

We have experienced 36 cases of OPLL from 1980 to 1999. Of those, 20 cases underwent anterior decompression longer than 2 intervertebral spaces. Age was 44–73 (mean 55). Average preoperative period was 3.3 years. Ossified ligament, attached intraspinal osteophytes and involved dura were removed in all cases. Spinal stabilization was accomplished with the placement of an iliac bone graft (1–4 levels).

Results:

Functional recovery was good to excellent in 33 of 36 patients (91%); it was fair in 2 (5.5%); it was poor in 1 (2.8%). Fair and poor cases were disabled preoperatively and showed unsatisfactory or no neurological improvement postoperatively. Two were reoperated for the displacement of iliac bone graft. One experienced epidural hematoma. Large dural defect occurred in 3 cases of which ossified ligaments occupied more than 70% of the spinal canal; one showed poor result. Major predictive factor was severity of preoperative neurological deficits and degree of canal stenosis.

Conclusion:

The anterior approach relieves the major source of spinal cord compression and prevents its recurrence. This approach also prevents the development of kyphotic deformity of the cervical spine. However, this approach should be carefully applied for severely disabled patients.