43 - Ossification of the Posterior Longitudinal Ligament

Abstract

Ossification of the posterior longitudinal ligament (OPLL) is an important disorder of the spine and has a relatively high prevalence in East Asian countries. In the natural course of this disease, half of the patients affected have progression of ossification, which may lead to myelopathy and to an increased risk for spinal cord injury after minor trauma. OPLL is usually diagnosed by x-ray. With the advancement of computed tomography imaging, diagnostic accuracy is enhanced, and concurrent ossified ligaments are identified in patients with OPLL. Because only a few studies have demonstrated the validity of nonoperative treatment, surgery should be performed if the patient presents with neural symptoms or neurological deterioration. Several techniques have been used in the treatment of cervical OPLL: an anterior approach, posterior decompression and fusion, and laminoplasty. As each procedure has advantages and shortcomings, their indications should be cautiously considered according to the pathological condition. The three primary surgical treatments for thoracic OPLL are as follows: posterior laminectomy and fusion, anterior decompression via a posterolateral approach with posterior fusion, and circumferential decompression and fusion via a combined anterior and posterior approach. However, 50% of thoracic OPLL patients who undergo surgery develop complications. Among the adverse events, motor palsy in the lower extremities has the highest incidence (32%). Therefore, it is necessary to be aware of the potential risks of surgery associated with each approach and to explain the different risks to patients before surgery.