Surgical options in treating Ossification of the Posterior Longitudinal Ligament (OPLL): a single center experience

BACKGROUND: Ossified posterior longitudinal ligament (OPLL) of the cervical spine can lead to spinal stenosis and become clinically symptomatic. The optimal approach in addressing OPLL is a debated topic and dependent on factors such as preoperative lordosis and levels affected.

METHODS: In this study, we retrospectively identified patients undergoing operative management for OPLL. Demographics, operative details, radiographic parameters, outcome measurements, and complications were compared between the different approaches for OPLL treatment.

RESULTS: There were 44 patients identified total with 16 undergoing laminoplasty (Plasty), 18 anterior corpectomy and discectomy (Ant), and 10 laminectomy and instrumentation (Linst). Ant had least OPLL levels with median (range) 3 (2 - 5), compared to Plasty 4 (2 - 7) and Linst 4 (3 - 6). Plasty was associated with the shortest operative time and hospital stay. Ant showed significant correction in kyphosis from 0.5° (-13° _ 16°) to 9.5° (-7° _ 20°). There was loss in lordosis in Plasty and Linst. Sagittal balance significantly increased irrespective of surgical approach with the least increase in Ant group. Complications were least in Plasty group with similar overall improvement in outcome measurements.

CONCLUSION: All 3 approaches in the management of OPLL were associated with clinical improvement without one approach surpassing the others. Laminoplasty had the advantage of addressing more levels of stenosis than the anterior approach and associated with a shorter operating time. Laminoplasty patients had a shorter hospital stay than those undergoing laminectomy and instrumentation and appeared to have less complications than the other approaches. Laminoplasty is the preferred approach in patients with preserved motion and lordosis, with the anterior approach effective in the correction of kyphosis.