Surgical Indications and Choice of Surgical Procedure for Cervical Ossification of the Longitudinal Ligament

Abstract

Patients with cervical ossification of the longitudinal ligament (OPLL) who have myelopathy usually require surgery. There are two main options in the surgical procedure: anterior decompression and fusion (ADF), or the posterior approach including various types of laminoplasty. ADF can achieve good surgical results by direct decompression; however, many spine surgeons often feel hesitant performing ADF due to its technical difficulties and high incidence of surgery-related complications. In contrast, the posterior approach has been widely used since it is less technically demanding and less frequently associated with serious complications. Nevertheless, there are several limiting factors for the indication of posterior approach because of its nature of indirect decompression. Thus, each procedure has both advantages and disadvantages. The choice of surgical procedure has always been controversy and there has been no clear guideline for choosing surgical procedures. Several studies, such as meta-analysis, recently have been published. Based on the accumulation of research over many years, it is recommended that spine surgeons make a more appropriate decision about choice of the procedure for each pathomechanism, if not enough evidence is found. In this chapter, we summarize the long-time controversy over the issue and discuss the choice of procedure based on the latest information.