title: Conservative management of ossification of the posterior longitudinal ligament. A review.
abstract: OBJECTIVE
  Ossification of the posterior longitudinal ligament (OPLL) can result in significant myelopathy. Surgical treatment for OPLL has been extensively documented in the literature, but less data exist on conservative management of this condition.
  
  
  METHODS
  The authors conducted a systematic review to identify all reported cases of OPLL that were conservatively managed without surgery.
  
  
  RESULTS
  The review yielded 11 published studies reporting on a total of 480 patients (range per study 1-359 patients) over a mean follow-up period of 14.6 years (range 0.4-26 years). Of these 480 patients, 348 (72.5%) were without myelopathy on initial presentation, whereas 76 patients (15.8%) had signs of myelopathy; in 56 cases (15.8%), the presence of myelopathy was not specified. The mean aggregate Japanese Orthopaedic Association score on presentation for 111 patients was 15.3. Data available for 330 patients who initially presented without myelopathy showed progression to myelopathy in 55 (16.7%), whereas the other 275 (83.3%) remained progression free. In the 76 patients presenting with myelopathy, 37 (48.7%) showed clinical progression, whereas 39 (51.5%) remained clinically unchanged or improved.
  
  
  CONCLUSIONS
  Patients who present without myelopathy have a high chance of remaining progression free. Those who already have signs of myelopathy at presentation may benefit from surgery due to a higher rate of progression over continued follow-up.
authors: Department of Neurosurgery, Keck School of Medicine, University of Southern California, LAC+USC Medical Center, 1200 North State Street, Los Angeles, CA 90089, USA. martin.pham@usc.edu
authors: Martin H
authors: MH
authors: Pham
authors: Frank J
authors: FJ
authors: Attenello
authors: Joshua
authors: J
authors: Lucas
authors: Shuhan
authors: S
authors: He
authors: Christopher J
authors: CJ
authors: Stapleton
authors: Patrick C
authors: PC
authors: Hsieh
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D019468:Disease Management; D018450:Disease Progression; D006801:Humans; D017846:Longitudinal Ligaments / Q000473:pathology / Q000601:surgery; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy