title: Surgical Outcomes of the Ossification of the Posterior Longitudinal Ligament According to the Involvement of the C2 Segment.
abstract: OBJECTIVE
  The complex structure around the upper cervical spine makes surgical treatment difficult. the present study aimed to analyze how patients with ossification of the longitudinal ligament (OPLL) involving the C2 were managed and to compare the surgical outcomes according to the C2 involvement.
  
  
  METHODS
  Ninety-five patients with cervical OPLL who underwent surgical treatment were divided into C2 involvement (C2+ group, 40 patients) or none (C2- group, 55 patients). In the C2+ group, subanalysis was conducted to according to the C2 surgery (C2 surgery+ group, 14 patients).
  
  
  RESULTS
  All patients had a minimum of 1 year of follow-up with a mean of 51.36 months. The most common location of the narrowest space available for the spinal cord was C2 and C5 in the C2+ and C2- groups, respectively. In the C2+ group, a longer OPLL with thickened diameter was radiographically demonstrated, but clinical outcomes were not different from the C2- group. In the C2 surgery+ group, the narrowest spinal cord was common in the C2 (50.0%), and an extension of the signal change of spinal cord to the C2 was observed in 4 patients, showing a statistical difference. C2 surgery was performed in all patients using the posterior approach and it did not result in different clinical outcomes or surgery-related complications. An anterior surgical approach was deemed risky given the chance of the development of complications.
  
  
  CONCLUSIONS
  Both of C2 involvement from OPLL and surgery including the C2 did not affect clinical outcomes. The posterior decompressive surgery is safer and more effective than the anterior approach regarding the development of surgery-related complications.
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Soo Eon
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: taj@snu.ac.kr.
authors.forename: Tae-Ahn
authors.initials: TA
authors.lastname: Jahng
authors.affiliation: Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Hyun-Jib
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D017887:Ossification of Posterior Longitudinal Ligament / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: C2; Decompressive surgery; Ossification of the posterior longitudinal ligament; Upper cervical spine