Choice of surgical procedure

Abstract

With ossifi cation of the longitudinal ligament (OPLL), the pathological lesion lies in front of the spinal cord, and its removal has been thought to be a radical treatment from the time of its fi rst recognition. Thus, attempts to remove the ossifi ed lesion were abandoned because of the technical diffi culty. With the development of surgical instruments and techniques for spinal surgery, access to the ossifi ed lesion by resecting the vertebral body, such as the fl oating method described by Yamaura et al. [1], have been developed. Since then, the choice of procedure has been the subject of argument among spine surgeons. A surgical procedure that is most appropriate for the articular pathomechanism in each patient should be chosen. However, the mechanism behind the myelopathy in most patients with OPLL is multifactorial, so it is diffi cult clinically to clarify the exact pathomechanism of the myelopathy in a particular patient. Hence, arguments over the choice of surgical procedure for the condition have continued and are based on speculation about the pathomechanism and the clinical and laboratory evaluations, including a neurological examination, radiographic examination, the degree of surgical invasiveness, and possible surgical complications. This means that at this moment no criteria for choosing a surgical procedure have been established based on scientifi c evidence. In this chapter we summarize the longtime argument over this issue and discuss the choice of procedure for the condition. © Springer 2006.