Positive effect of posterior instrumentation after surgical posterior decompression for extensive cervicothoracic ossification of the posterior longitudinal ligament.
METHODS
A case report of a 55-year-old patient with extensive cervicothoracic ossification of the posterior longitudinal ligament (OPLL) that was treated with posterior decompression and fusion.


OBJECTIVE
To report the preventive effect of posterior instrumentation on postoperative paralysis in extensive cervicothoracic OPLL.


BACKGROUND
Thoracic myelopathy caused by OPLL in the thoracic spine was treated with operative decompression of the spinal cord via an anterior, posterior, or posterolateral approach. However, the lack of availability for some approaches in specific cases, as well as reports of some problems for each approach, indicates that a lack of consensus still remains regarding the choice of operative procedure.


METHODS
A 55-year-old female with extensive cervicothoracic OPLL presented with progressive numbness in the both hands and a gate disturbance. Cervical laminoplasty, thoracic laminectomy, and posterior fusion were performed with electrophysiologic monitoring of the spinal cord evoked potential.


RESULTS
After thoracic laminectomy, the amplitude of spinal cord evoked potential waveforms decreased but recovered after a posterior fusion by instrumentation.


CONCLUSIONS
Prevention of postoperative paralysis from increasing by posterior instrumentation was shown using neurophysiologic monitoring.
Nakanishi
Kazuyoshi
K
Division of Clinical Medical Science, Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. kazn@hiroshima-u.ac.jp
Tanaka
Nobuhiro
N
Nishikawa
Koichiro
K
Fujimoto
Yoshinori
Y
Ochi
Mitsuo
M
D002574:Cervical Vertebrae; D019299:Decompression, Surgical / Q000295:instrumentation* / Q000379:methods*; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D017887:Ossification of Posterior Longitudinal Ligament / Q000601:surgery*; D010243:Paralysis / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D013117:Spinal Cord Compression / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae