The surgical management of ossification of the posterior longitudinal ligament in 51 patients.

Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine warrants unique clinical, radiographic, and surgical management. OPLL patients presenting with severe myelopathy require full assessment with both magnetic resonance imaging (MRI) and computed tomography-based (noncontrast CT, myelo-CT, three-dimensional CT) examinations to document the full extent of their disease. Whether better surgical outcomes are attained after anterior resection (diskectomy/corpectomy), rather than posterior decompression (laminectomy/laminoplasty) of OPLL remains controversial. However, our recent experience with 51 OPLL patients indicates superior results after anterior (41 patients) versus posterior (10 patients) surgery. Continuous intraoperative somatosensory evoked potential (SSEP) monitoring also appears to limit operative morbidity.