“Only Spinal Fixation” as Surgical Treatment of Cervical Myelopathy Related to Ossified Posterior Longitudinal Ligament: Review of 52 Cases

Abstract

Background: Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic condition resulting in a progressive narrowing of the spinal canal and subsequent neurologic deficits. Although systemic and local factors in combination with genetic abnormality have been considered in its etiopathogenesis, OPLL remains a poorly understood pathology. Surgical management of OPLL and the choice of the most appropriate treatment are still controversial issues. Here the authors report a series of OPLL-affected patients treated by “only-fixation” technique. Methods: Between June 2012 and June 2019, 52 patients having OPLL were treated by a surgical strategy involving only spinal fixation without any form of bone or soft tissue decompression. Facetal fixation for both the atlantoaxial and subaxial spine formed the basis of the surgical treatment. Clinical parameters, analysis of video recordings before and after surgery, and patient self-assessment were included in the analysis of outcome. Results: During the mean follow-up period there was an immediate postoperative and progressive recovery in symptoms in 51 patients. Of 14 patients who were wheelchair bound before surgery, 12 walked independently on follow-up assessment of 6 months. All patients had successful arthrodesis in the surgically treated segments. There were no infective- or implant-related complications. Conclusions: Decision making in the surgical management of cervical OPLL is still controversial. The concept of spinal instability has been shown to be a nodal point in the pathogenesis of OPLL, and “only-spinal fixation” can be considered a rationale for an appropriate surgical treatment.