Anterior surgery in selective patients with massive ossification of posterior longitudinal ligament of cervical spine: technical note.

摘要

STUDY DESIGN: The study includes case series, technical note and review of literature. OBJECTIVE: The objective of this study was to assess the validity of the radiographic indicator and the result of anterior operation for massive ossification of posterior longitudinal ligament (MOPLL, ossification of posterior longitudinal ligament with an occupying ratio exceeding 50%). Anterior decompression yielded a better outcome than posterior approach in patients with MOPLL of cervical spine. But anterior surgery has the problem of technically demanding and was associated with a high incidence of surgery-related complications. Many ways for reducing the risk of anterior surgery have been reported, including floating method, employing microscopes or burrs, and laser-assisted corpectomy. MATERIALS AND METHODS: A case series of selective patients with MOPLL of cervical spine undergoing anterior surgery is reported. All patients were strictly selected based on CT images with the appearance of open-base. 29 cases with more than 12 months follow-up (average, 31.0 +/- 10.0 m) were reviewed. Average age at operation was 59.3 +/- 8.2 years (43-73 years). Anterior decompression was done only for one or two vertebrae. RESULTS: One corpectomy was done in 13 cases, two corpectomies in 3 cases, and one corpectomy and one discectomy in 13 cases. Three levels were fused in 16 cases and two levels in 13 cases. No permanent neurological deterioration was observed. Neurological improvement was observed in every patients with an average improvement rate of 64 +/- 23%. Mesh migration was observed in one case. A fusion rate of 100% was achieved. CONCLUSION: Anterior surgery using our technique may be a relatively simple and safe procedure in selective patients with massive ossification of posterior longitudinal ligament of cervical spine.