From the Guidelines
Cervical ossification of the posterior longitudinal ligament (OPLL) treatment typically begins with conservative management for mild cases, but surgery is recommended for patients with progressive neurological deficits, severe spinal cord compression, or intractable pain. The main surgical approaches include anterior decompression and fusion (ADF) for localized OPLL affecting 1-3 levels, which directly removes the ossified ligament and relieves pressure on the spinal cord 1. For more extensive OPLL spanning multiple levels, posterior approaches such as laminoplasty or laminectomy with fusion are preferred, as they indirectly decompress the spinal cord by creating more space in the spinal canal.
Key Considerations
- The choice between anterior and posterior approaches depends on the extent of OPLL, sagittal alignment of the spine, presence of instability, and the patient's overall health status.
- Postoperatively, patients require rehabilitation to regain strength and function, with regular follow-up imaging to monitor for disease progression or recurrence.
- The goal of treatment is to prevent further neurological deterioration, relieve pain, and maintain spinal stability while preserving as much neck mobility as possible.
Diagnostic Imaging
- CT evaluation can show OPLL type, thickness, length of involved segments, and associated systemic diseases, such as patients with new or increasing nontraumatic diffuse idiopathic skeletal hyperostosis 1.
- MRI is useful in the assessment of cord abutment/signal changes secondary to spinal canal narrowing, and to evaluate the exiting nerve roots in the setting of radiculopathy.
Treatment Options
- Conservative management: physical therapy, anti-inflammatory medications like NSAIDs, and neck braces for temporary support.
- Surgical management: anterior decompression and fusion (ADF), laminoplasty, or laminectomy with fusion.
- The most recent and highest quality study 1 supports the use of surgical management for patients with progressive neurological deficits, severe spinal cord compression, or intractable pain.
From the Research
Treatment Options for Cervical Ossification of the Posterior Longitudinal Ligament (OPLL)
The treatment options for Cervical Ossification of the Posterior Longitudinal Ligament (OPLL) include:
- Surgical management, which can be performed through an anterior or posterior approach 2, 3, 4, 5
- Anterior decompression with fusion, which is often used for patients with ossification of a small length of the posterior longitudinal ligament (< 7 cm) 3
- Posterior decompression via techniques such as laminoplasty and laminectomy, which is often used for patients with multi-segment pathology and/or developmental canal stenosis 3
- "Only spinal fixation" technique, which involves facetal fixation for both the atlantoaxial and subaxial spine without any form of bone or soft tissue decompression 6
Surgical Approaches
The choice of surgical approach depends on various factors, including:
- The classification and extent of OPLL 4
- Cervical spine sagittal alignment 4
- Severity of stenosis 4
- History of previous surgery 4
- The percentage of canal occupancy by OPLL, with anterior approach being more suitable for patients with >50% occupancy 5
Outcomes and Complications
The outcomes and complications of surgical treatment for OPLL include:
- Good functional outcomes in 50-70% of patients 3
- Development of complications such as deterioration of myelopathy and C5 palsy in 0-10% of patients 3
- Postoperative kyphotic deformity in 9% of patients after posterior decompression surgery 3
- Implant failures in patients with high occupancy OPLLs treated with posterior approach 5