title: Is Only Stabilization the Ideal Treatment for Ossified Posterior Longitudinal Ligament? Report of Early Results with a Preliminary Experience in 14 Patients.
abstract: OBJECTIVE
  Surgical treatment of ossified posterior longitudinal ligament (OPLL) continues to be wrought with confusion, debate, and arguments. We report our experience with an alternative form of treatment that involves only fixation of the involved spinal segments. We report and put on record our remarkably gratifying clinical experience in 13 of 14 patients having OPLL after surgery that involved only facetal fixation and aimed at arthrodesis of involved spinal segments. No direct bone, ligament, or disc resection was done for decompression of the spinal dural tube or root canal. The OPLL was not directly handled during the surgical procedure. The rationale of the proposed treatment is discussed.
  
  
  METHODS
  During the period June 2012 to August 2014, 14 patients having OPLL were treated by facetal transarticular screw fixation technique. The Japanese Orthopaedic Association score, visual analogue scale, and Odom's criteria were used as indices to monitor the clinical status.
  
  
  RESULTS
  The procedure resulted in firm stabilization and fixation of the spinal segments and provided a ground for arthrodesis. During an average follow-up period of 17 months, there was immediate postoperative and progressive recovery in symptoms in 13 patients. There were no surgery or implant-related mechanical or infective complications.
  
  
  CONCLUSIONS
  Instability could be the defining phenomenon in pathogenesis of clinical symptoms related to OPLL. The clinical outcome in our patients suggests that only fixation of the spinal segments can be a simple, safe, and rationale form of treatment for the complex pathology of OPLL.
authors.affiliation: Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India; Consultant Neurosurgeon, Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India. Electronic address: atulgoel62@hotmail.com.
authors.forename: Atul
authors.initials: A
authors.lastname: Goel
authors.affiliation: Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
authors.forename: Trimurti
authors.initials: T
authors.lastname: Nadkarni
authors.affiliation: Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
authors.forename: Abhidha
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
authors.forename: Survendra
authors.initials: S
authors.lastname: Rai
authors.affiliation: Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
authors.forename: Vithal
authors.initials: V
authors.lastname: Rangarajan
authors.affiliation: Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Kulkarni
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis; D001863:Bone Screws; D005260:Female; D005592:Fracture Fixation; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D017846:Longitudinal Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D017887:Ossification of Posterior Longitudinal Ligament / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000473:pathology; D016896:Treatment Outcome
keywords: Instability; Ossified posterior longitudinal ligament; Transarticular screws