Treatment of OPLL and OLF of the Cervical Spine: Long-Term Results

Abstract

Surgical intervention is indicated in patients with severe symptoms, mainly cervical myelopathy, due to ossifi cation of the posterior longitudinal ligament (OPLL). This chapter reviews the long-term surgical outcomes in patients with cervical OPLL. Operative methods are divided into two procedures: anterior decompression surgery and posterior decompression surgery. Combined surgery—anterior and posterior decompression—is occasionally carried out. Most surgeons consider the patient’s general condition, the type of OPLL, and the severity of the cervical myelopathy to determine the surgical choice. Hirabayashi and Toyama reported indications for the particular operative method (Table 1) [1]. In general, anterior surgery is performed in patients with fewer than oneor two-level OPLL lesions, whereas posterior surgery is done in patients with lesions at more than three levels. Therefore, posterior surgery is predominantly performed for OPLL. In our clinic, the choice of surgery was anterior in 10%–20% of the patients with OPLL and posterior in 80%–90%. There are numerous reviews regarding postoperative outcomes of anterior and posterior surgery for treating patients with OPLL. Several reports have described the long-term surgical results for each procedure.