A patient with two re-surgeries for delayed myelopathy due to progression of ossification of the posterior longitudinal ligaments after cervical laminoplasty.
METHODS
Case report.


OBJECTIVE
To discuss the development of delayed myelopathy due to the progression of ossification of the posterior longitudinal ligament (OPLL) after cervical laminoplasty.


BACKGROUND
The progression of OPLL after cervical laminoplasty for the treatment of OPLL is often shown in long-term follow-up; however, few patients with reoperation due to OPLL progression have been reported.


METHODS
The patient was a 70-year-old male carpenter. At 57-years of age, he underwent open door laminoplasty between C3 and C7 with dome-like laminectomy of C2 for the treatment of myelopathy due to mixed-type OPLL (continuous type at C3-C4 and segmental type at C5). Five years after the initial surgery, the disorder of skilled motor activity in the bilateral hands and ambulatory difficulties recurred as a result of cranial progression of OPLL (between C2 and C4). He underwent laminectomy and posterior fusion between C2 and C5 and returned to work. Four years after resurgery, the same symptoms recurred.


RESULTS
CT revealed the progression of OPLL thickness at C5 level and longitudinal progression of OPLL to C6/7. Sagittal view of MRI demonstrated spinal cord compression between C5 and C6/7 because of OPLL at C5 and hypertrophic ligamentum flavum at C5-C6 and C6-C7. Posterior fusion extending up to C7 with laminectomy of C6 and C7 was performed. His symptoms were alleviated and he could walk again.


CONCLUSIONS
We reported a patient with OPLL who had undergone resurgery twice because of myelopathy due to the progression of ossification. It was important to establish a sufficiently longitudinal and transverse decompression, taking the risk of the unexpected progression of ossification into consideration.
Tokuhashi
Yasuaki
Y
Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo, Japan. ytoku@med.nihon-u.ac.jp
Ajiro
Yasumitsu
Y
Umezawa
Natsuki
N
D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D007796:Laminectomy / Q000009:adverse effects / Q000379:methods; D017843:Ligamentum Flavum / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D017887:Ossification of Posterior Longitudinal Ligament / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D011859:Radiography; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D013117:Spinal Cord Compression / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome