Anterior longitudinal decompression in the management of severe ossification of the posterior longitudinal ligament in the cervical spine.

Full article available online at Healio.com/Orthopedics Figure: Lateral radiograph showing cervical degeneration. The advantages of anterior surgery for severe ossification of the posterior longitudinal ligament in the cervical spine have been reported. However, it is more technically demanding and associated with a high risk of surgery-related complications. The purpose of this study was to evaluate the feasibility of longitudinal decompression techniques in anterior surgery for severe ossification of the posterior longitudinal ligament in the cervical spine. Between June 2008 and December 2011, twenty-two patients (16 men and 6 women; average age, 58 years [range, 45-72 years]) who underwent anterior corpectomy and fusion for severe ossification of the posterior longitudinal ligament were studied retrospectively. The clinical efficacy, canal narrowing ratio, fused segment height, and complications were investigated. After a mean 25.4-month follow-up, mean Japanese Orthopaedic Association score increased from 8.8±1.4 preoperatively to 14.0±1.2 at final follow-up (P .05). Five patients developed cerebrospinal fluid leakage, and 1 patient experienced hematoma. No instrument failure was observed, and all patients had successful fusion. Anterior longitudinal decompression is a relatively effective procedure in the management of severe ossification of the posterior longitudinal ligament in the cervical spine. It can be applied to treat closed-base ossification of the posterior longitudinal ligament (defined as no space between the lateral margin of the ossified base and the spinal canal lateral wall), but it is associated with a high risk of cerebrospinal fluid leakage. The authors are from the Department of Spine Surgery, Third Hospital of HeBei Medical University, Shijiazhuang, China. The authors have no relevant financial relationships to disclose. The authors thank Dr Liu Fajing, Department of Orthopaedic Surgery, HanDan Central Hospital, for the valuable suggestions and assistance with statistical analysis. Correspondence should be addressed to: Yong Shen, MD, Department of Spine Surgery, Third Hospital of HeBei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, China (shenyongspine2012@126. com). Received: September 4, 2013; Accepted: November 8, 2013; Posted: May 14, 2014. doi: 10.3928/01477447-20140430-58 Anterior Longitudinal Decompression in the Management of Severe Ossification of the Posterior Longitudinal Ligament in the Cervical Spine Tao Lei, MD; Yong Shen, MD; Lin Feng Wang, MD; Wen Yuan Ding, MD; Di Zhang, MD; Peng Zhang, MD; Wei Du, MD; Jia Li, MD