Cervical ossification of the posterior longitudinal ligament surgery complications

Anterior surgery carries surgery-related risks such as cerebrospinal fluid (CSF) leakage, spinal cord damage, instrumentation-related complications, and dyspnea or dysphagia. In contrast, posterior decompression with or without relatively long fusion offers an alternative that may allow decompression of the spinal cord and correction of spinal alignment to some extent 1) 2) 3).

Although posterior surgery may reduce the surgical risks associated with anterior cervical surgery, it still carries a high risk of nerve root tethering or cervical foraminal stenosis or additional neurological deficit related to the remaining OPLL 4) 5).

Patients with dural ossification are at a higher risk of CSF leakage during anterior cervical removal of OPLL because it is technically challenging to separate OPLL from ossified dura mater. To prevent leakage of CSF both during and after surgery, the surgeon can select a surgical strategy such as the floating method, prepare abdominal fat tissue for grafting onto the dura mater, or initiate lumbar drainage immediately after surgery. If indirect decompression of the spinal cord from OPLL is performed by a posterior decompression surgery such as laminoplasty, the surgeon should be aware of postoperative dynamic change in OPLL 6).

Iwasaki M, Kawaguchi Y, Kimura T, et al. Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg 2002;96(2 Suppl):180-9.
Iwasaki M, Okuda S, Miyauchi A, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty. Spine (Phila Pa 1976) 2007;32:647-53.
Tani T, Ushida T, Ishida K, et al. Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament. Spine (Phila Pa 1976) 2002;27:2491-8.
Chiba K, Yamamoto I, Hirabayashi H, et al. Multicenter study investigating the postoperative progression of ossification of the posterior longitudinal ligament in the cervical spine: a new computer-assisted measurement. J Neurosurg Spine 2005;3:17-23.
Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 1981;6:354-64.
Shimokawa N, Sato H, Matsumoto H, Takami T. Review of Radiological Parameters, Imaging Characteristics, and Their Effect on Optimal Treatment Approaches and Surgical Outcomes for Cervical Ossification of the Posterior Longitudinal Ligament. Neurospine. 2019 Sep;16(3):506-516. doi: 10.14245/ns.1938268.134. Epub 2019 Sep 30. PubMed PMID: 31607082; PubMed Central PMCID: PMC6790724.
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