Extensive laminectomy for the treatment of ossification of the posterior longitudinal ligament in the cervical spine

Abstract

Objective: To introduce the surgical strategy of extensive laminectomy (with inner 1/4 facet joint resection to expose the origin of the nerve root) and to discuss its benefit for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) with myelopathy.

Methods: From January 1998 to December 2005, 82 patients with cervical OPLL underwent extensive laminectomy. We assessed neurological function using the Japanese Orthopedic Association (JOA) scoring system, neck/shoulder pain using a visual analogue scale (VAS), and cervical curvature index (CCI) by the Ishihara method; the expansion degree and the drift-back distance of the spinal cord was calculated using the MRI image.

Results: The mean duration of follow-up was 41.6 months. The postoperative JOA score suggested that neurological function improved significantly with a recovery rate of 64%. The incidence rate of transient palsy of the C5 nerve root, which occurred in only 2 patients who recovered to useful function over 2 weeks, was 2.4%. The postoperative VAS score suggested that the pain in the neck/shoulder was mild. Although the postoperative CCI was small, there was no correlation with the length of follow-up period. The increased cross-sectional area of the dural sac at the level of maximum compression together with the significant drift-back distance of the spinal cord suggested that decompression was complete.

Conclusion: Extensive laminectomy is effective in treating cervical OPLL, with mild cervical/shoulder pain, low rate of C5 nerve root palsy, and no recurrence of spinal cord compression symptoms.