Concepts of posterior decompressive surgery

Abstract

Countries in East Asia have a high prevalence of myelopathy related to ossification of the posterior longitudinal ligament (OPLL). Due to an ossified ligamentous compression of the spinal cord from anterior, progressive cervical myelopathy results in a high level of disability. In the 1960s, cervical laminectomy that completely removes laminae with attached ligamentous structures was the only available surgical procedure for cervical myelopathy. Decompression was achieved with a posterior shift of the spinal cord by removing posterior elements of the cervical spine. However, the surgical outcomes were rather unpredictable due to various complications, such as iatrogenic spinal cord injury and recurrent myelopathy caused by the epidural scar formation or development of postoperative kyphosis.