TY - JOUR
T1 - Ossification of the posterior longitudinal ligament
T2 - Surgical approaches and associated complications
AU - Head, Jeffery
AU - Rymarczuk, George
AU - Stricsek, Geoffrey
AU - Velagapudi, Lohit
AU - Maulucci, Christopher
AU - Hoelscher, Christian
AU - Harrop, James
N1 - Publisher Copyright:
© 2019 by the Korean Spinal Neurosurgery Society.
PY - 2019/9
Y1 - 2019/9
N2 - Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.
AB - Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.
KW - Cervical vertebrae
KW - Neurosurgical procedures
KW - Ossification of posterior longitudinal ligament
KW - Postoperative complications
KW - Spinal diseases
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U2 - 10.14245/ns.1938222.111
DO - 10.14245/ns.1938222.111
M3 - Article
C2 - 31607083
AN - SCOPUS:85073802307
SN - 2586-6583
VL - 16
SP - 517
EP - 529
JO - Neurospine
JF - Neurospine
IS - 3
ER -