Circumspinal decompression with dekyphosis stabilization for thoracic myelopathy due to ossification of the posterior longitudinal ligament

Abstract

Introduction Ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine is likely to be multiple or extensive. In patients with thoracic myelopathy resulting from OPLL, removing the OPLL is the most effective method for relieving pressure on the spinal cord [1-6], but the anterior approach for removing OPLL plaque is technically demanding. Postoperative neurological degradation has been reported in several articles [1,7]. Especially when the OPLL plaque is large and the spinal cord is pinched between the plaque and the inner cortex of the posterior arch or there is Ossification of the ligamentum fl avum (OLF), anterior removal of the OPLL plaque is extremely dangerous for the already debilitated spinal cord [3,8]. Many authors have reported that extensive posterior decompression provided posterior shift of the spinal cord, which was indirect decompression of the spinal cord [9-12]. Some authors have tried to prevent postoperative kyphosis by laminoplasty or fusion with bone grafting supported by instrumentation [9,11,12]. These procedures have not always provided satisfactory results, however, because the OPLL plaque is left in place and may still compress the spinal cord owing to the posterior shift of the spinal cord [3-5]. Thus, anterior decompression is the best approach for spinal cord recovery when treating thoracic myelopathy caused by OPLL [1-6]. We reported our original technique of circumspinal decompression for thoracic OPLL and OLF, including safe removal of the OPLL plaque, in 1990 [3,4]. We have since improved this surgical procedure by introducing the concept of dekyphosis stabilization [8].. © 2006 Springer.