Overview of treatment for ossification of the longitudinal ligament and the ligamentum flavum

Abstract

Introduction The Investigation Committee on Ossification of the Spinal Ligaments, subsidized by the Japanese Ministry of Health, Labor, and Welfare, has conducted various studies of the ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum fl avum (OLF) since 1975. In 2002, the Committee established a subcommittee on clinical practice guidelines, which set out to systematically review articles on OPLL. This review, presented in this chapter, is based on knowledge obtained by that subcommittee. For cervical myelopathy secondary to OPLL, modalities that have been applied for myelopathy due to spondylosis and disc herniation have been adopted for the most part. When strictly classifying modalities for OPLL, the treatment is either conservative or surgical; the former includes (1) a cervical orthosis and halter or skull traction that aims to avoid the effects of dynamic factors; (2) corticosteroids for spinal cord edema; (3) nonsteroidal antiinfl ammatory drugs (NSAIDs) for pain control; (4) bisphosphonates to prevent progression of the ossification; and (5) alternative medicine for pain control. The latter consists of spinal cord decompression by an anterior or posterior procedure and spinal stabilization. © Springer 2006.