title: Postoperative magnetic resonance imaging assessment for potential compressive effects of retained posterior longitudinal ligament after anterior cervical fusions: a cross-sectional study.
abstract: METHODS
  A cross-sectional study.
  
  
  OBJECTIVE
  To assess using postoperative magnetic resonance imaging whether the posterior longitudinal ligament (PLL) caused residual cord compression after anterior cervical decompression and fusion (ACDF) in a series of patients in whom the PLL was retained.
  
  
  BACKGROUND
  There is a lack of data evaluating the postoperative compressive effects of the PLL in patients undergoing ACDF providing guidance as to whether to remove or retain the PLL during discectomy to facilitate adequate decompression.
  
  
  METHODS
  Postoperative gadolinium enhanced magnetic resonance images were reviewed in a series of 33 patients who underwent ACDF for cervical radiculomyelopathy and who had persistent or recurrent postoperative symptoms. Patients with ossification of the posterior longitudinal ligament or with a herniated disc behind the PLL were excluded from this study.
  
  
  RESULTS
  There were no cases of discernible compression by the retained PLL identified on the magnetic resonance image (P < 0.001) as assessed by 2 independent reviewers. Four patients underwent subsequent revision surgery unrelated to the PLL.
  
  
  CONCLUSIONS
  We were unable to demonstrate magnetic resonance imaging evidence to suggest that the retained PLL caused compression after ACDF in this patient cohort. Therefore we suggest that removing the PLL should be considered for reasons other than concern about residual compression.
authors.affiliation: Institute for Modern & Innovative Surgery (iMIS), Fort Lauderdale, FL 33311, USA. Kingsleychin@gmail.com
authors.forename: Kingsley R
authors.initials: KR
authors.lastname: Chin
authors.forename: Gary
authors.initials: G
authors.lastname: Ghiselli
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cumming
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Furey
authors.forename: Jung U
authors.initials: JU
authors.lastname: Yoo
authors.forename: Sanford E
authors.initials: SE
authors.lastname: Emery
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D003430:Cross-Sectional Studies; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D016015:Logistic Models; D017846:Longitudinal Ligaments / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000000981:diagnostic imaging*; D013123:Spinal Fusion / Q000379:methods*