title: Surgical management of cervical ossification of the posterior longitudinal ligament: natural history and the role of surgical decompression and stabilization.
abstract: OBJECTIVE
  Ossification of the posterior longitudinal ligament (OPLL) is a complex multifactorial disease process combining both metabolic and biomechanical factors. The role for surgical intervention and choice of anterior or posterior approach is controversial. The object of this study was to review the literature and present a single-institution experience with surgical intervention for OPLL.
  
  
  METHODS
  The authors performed a retrospective review of their institutional experience with surgical intervention for cervical OPLL. They also reviewed the English-language literature regarding the epidemiology, pathophysiology, natural history, and surgical intervention for OPLL.
  
  
  RESULTS
  Review of the literature suggests an improved benefit for anterior decompression and stabilization or posterior decompression and stabilization compared with posterior decompression via laminectomy or laminoplasty. Both anterior and posterior approaches are safe and effective means of decompression of cervical stenosis in the setting of OPLL.
  
  
  CONCLUSIONS
  Anterior cervical decompression and reconstruction is a safe and appropriate treatment for cervical spondylitic myelopathy in the setting of OPLL. For patients with maintained cervical lordosis, posterior cervical decompression and stabilization is advocated. The use of laminectomy or laminoplasty is indicated in patients with preserved cervical lordosis and less than 60% of the spinal canal occupied by calcified ligament in a "hill-shaped" contour.
authors: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Chicago, IL 60611, USA. p-sugrue@northwestern.edu
authors: Patrick A
authors: PA
authors: Sugrue
authors: Jamal
authors: J
authors: McClendon
authors: Ryan J
authors: RJ
authors: Halpin
authors: John C
authors: JC
authors: Liu
authors: Tyler R
authors: TR
authors: Koski
authors: Aruna
authors: A
authors: Ganju
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D019468:Disease Management; D005260:Female; D006801:Humans; D017846:Longitudinal Ligaments / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000209:etiology* / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies