Posterior extensive cervicothoracic laminoplasty

Abstract

Introduction Surgery for Ossification of the posterior longitudinal ligament (OPLL) is recognized as one of the most diffi cult operations to perform, especially in the thoracic spine. Direct excision of OPLL through an anterior approach is technically demanding, with concerns about spinal cord injury and other iatrogenic complications. Anterior decompression for extensive OPLL from the cervical to the thoracic spine is diffi cult because of the extent of the required exposure. The type of OPLL dictates the surgical method and approach. Localized and beak-shaped OPLL in the thoracic spine can be directly excised by either an anterior or a posterior approach. In the case of extensive OPLL from the cervical to the thoracic spine, posterior extensive cervicothoracic laminoplasty (PECTL) is a useful fi rst choice procedure. Laminoplasty through a posterior approach is an operation commonly performed by Japanese spine surgeons and is not as technically demanding as an anterior procedure. Moreover, because the procedure opens up the spinal canal, indirectly decompressing the cord, it reduces the risk of cord injury. Some results of PECTL have been reported [1,2], and its usefulness is widely recognized. Expansion is more diffi cult to achieve in the thoracic spinal canal than in the cervical spinal canal. We established the PECTL procedure as a method by which expansion of the spinal canal in the thoracic spine is reliably obtained. This article explains in detail the indications, operative technique, and clinical results of PECTL performed at our institution. © 2006 Springer.