Original ArticleSurgical Options in Treating Ossification of the Posterior Longitudinal Ligament: Single-Center Experience
Introduction
Ossified posterior longitudinal ligament (OPLL) involves the abnormal ectopic calcification of the posterior longitudinal ligament most often in the cervical spine.1, 2, 3, 4, 5 The prevalence of OPLL is reported to range from 1.9%−4.3% among the East Asian population and 0.1%−2.5% in the North American and European populations.2 Genetic factors encoding collagen (collagen type VI alpha 1 chain [COL6A1] and collagen type XI alpha 2 chain [COL11A2]) have been implicated in the pathogenesis of OPLL. Other genes important in the formation of bone, such as transforming growth factor beta (TGF-B) and bone morphogenic protein (BMP), also have increased expression in OPLL.3,4 The development of OPLL can lead to stenosis of the spinal canal and present with symptoms of radiculopathy or myelopathy and myelomalacia on magnetic resonance imaging (MRI) in severe cases. The definitive management of symptomatic OPLL is surgical decompression.
The optimal approach in addressing OPLL is a debated topic and dependent on factors such as preoperative lordosis and the levels affected.2 The anterior approach is often advocated in severe focal stenosis and kyphosis and is associated with better restoration of cervical lordosis.5, 6, 7, 8, 9 The posterior approach (laminoplasty or laminectomy and fusion) can often be effective in the decompression of multilevel stenosis where lordosis is still present.6,7 Laminoplasty may offer better retention of cervical motion, while laminectomy and fusion may offer better protection against the progression of kyphosis.10
In this study, we reviewed our department's experience managing patients with OPLL treated with laminoplasty (Plasty), anterior (Ant), or laminectomy and fusion (Linst) approaches. We examined the indications, radiographic parameters, complications, and outcomes associated with each approach.
Section snippets
Patient Population
We reviewed the records of patients with the diagnosis of OPLL with retrievable diagnostic imaging treated by our department since 2007. Our search (IRB 202002195) yielded 44 patients, 16 of whom were treated with laminoplasty, 18 with anterior corpectomy and diskectomy, and 10 with posterior laminectomy and instrumentation. Imaging studies reviewed included plain radiographs, MRI, and computed tomography (CT) scans of the cervical spine. Health-related outcomes were assessed before surgery and
Demographics and Operative Details
In the entire group, there were 27 men and 17 women with median ages of 58, range 39–74 years, and median BMI of 33, range 21–54. There was no significant difference in age or BMI between the 3 cohorts treated with Plasty, Ant, or Linst approaches (Table 1). The Linst group had the highest percentage (80%) of males. Presenting diagnosis was myelopathy in 10 (63%), 12 (67%), and 9 (90%) patients in the Plasty, Ant, and Linst groups, respectively. The remaining patients presented with neck or
Demographics and Diagnostics
There was no significant difference in the 3 cohorts in age and BMI. Linst had the highest percentage of males (80%), likely a result of small sample size, but all 3 cohorts showed a higher percentage of males compared with females. The frequency of OPLL at presentation in the sixth decade and predominance of males is reflected in other reports as well.2,7,9,15 There were also notable differences between the groups in presenting symptoms and K-line despite not reaching statistical significance
Conclusion
All 3 approaches in the management of OPLL were associated with clinical improvement without 1 approach surpassing the others. In our experience we continue to advocate for laminoplasty in the setting of multilevel stenosis without kyphosis because of our lower complication rate and shorter operating time with similar clinical benefit. We consider Linst in select cases with multilevel stenosis without kyphosis and various combinations of myelopathy, myelomalacia, or K-line negativity and Ant
CRediT authorship contribution statement
Brian J. Park: Conceptualization, Data curation, Formal analysis, Investigation, Validation, Writing - original draft, Writing - review & editing. Scott C. Seaman: Data curation, Formal analysis, Investigation, Validation, Writing - review & editing. Royce W. Woodroffe: Data curation, Formal analysis, Investigation, Validation, Writing - review & editing. Jennifer Noeller: Data curation, Formal analysis, Investigation, Writing - review & editing. Patrick W. Hitchon: Conceptualization, Data
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.