Nancy Epstein1. 1. Department of Neurological Surgery, The Albert Einstein College of Medicine, Bronx, NY, USA. don@psych.columbia.edu
Abstract
BACKGROUND CONTEXT: The diagnosis and treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL) is continuing to evolve as its effects become more readily recognized and surgical alternatives expand. PURPOSE: To review the clinical, neurodiagnostic and surgical management of OPLL. STUDY DESIGN/ SETTING: Patients with early OPLL, often in their mid-forties, present with radiculopathy or mild/moderate myelopathy. Radiographically, hypertrophy of the posterior longitudinal ligament with punctate ossification appears opposite multiple disc spaces. Patients with classic OPLL frequently become symptomatic in their mid-fifties with radiographic characteristics showing ossification of the ligament behind the vertebrae alone (segmental), behind the vertebrae including the intervertebral disc spaces (continuous), and combinations of the segmental and continuous variants and OPLL opposite disc spaces alone. Both magnetic resonance imaging (MRI) and computed tomography (CT) examinations are critical. MRI better delineates the extent of soft tissue abnormalities in three dimensions, including the cervicothoracic junction, whereas CT more readily identifies the foci of frank ossification. Surgical alternatives include anterior, posterior or combined approaches. Anterior surgical options include plated multilevel anterior discectomy and fusion, anterior cervical corpectomy with fusion (ACF), or plated multilevel ACF with differing posterior fusion techniques. Posterior surgical options vary from laminectomy with or without simultaneous fusion and laminoplasty. Although outcomes with different approaches vary, many direct anterior resection techniques achieve more favorable results because of appropriate and adequate resection of the ligament. CONCLUSIONS: The clinical and neuroradiographic documentation of OPLL and its appropriate surgical management anteriorly, posteriorly or circumferentially remain a therapeutic challenge.
BACKGROUND CONTEXT: The diagnosis and treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL) is continuing to evolve as its effects become more readily recognized and surgical alternatives expand. PURPOSE: To review the clinical, neurodiagnostic and surgical management of OPLL. STUDY DESIGN/ SETTING:Patients with early OPLL, often in their mid-forties, present with radiculopathy or mild/moderate myelopathy. Radiographically, hypertrophy of the posterior longitudinal ligament with punctate ossification appears opposite multiple disc spaces. Patients with classic OPLL frequently become symptomatic in their mid-fifties with radiographic characteristics showing ossification of the ligament behind the vertebrae alone (segmental), behind the vertebrae including the intervertebral disc spaces (continuous), and combinations of the segmental and continuous variants and OPLL opposite disc spaces alone. Both magnetic resonance imaging (MRI) and computed tomography (CT) examinations are critical. MRI better delineates the extent of soft tissue abnormalities in three dimensions, including the cervicothoracic junction, whereas CT more readily identifies the foci of frank ossification. Surgical alternatives include anterior, posterior or combined approaches. Anterior surgical options include plated multilevel anterior discectomy and fusion, anterior cervical corpectomy with fusion (ACF), or plated multilevel ACF with differing posterior fusion techniques. Posterior surgical options vary from laminectomy with or without simultaneous fusion and laminoplasty. Although outcomes with different approaches vary, many direct anterior resection techniques achieve more favorable results because of appropriate and adequate resection of the ligament. CONCLUSIONS: The clinical and neuroradiographic documentation of OPLL and its appropriate surgical management anteriorly, posteriorly or circumferentially remain a therapeutic challenge.