title: Is atlantoaxial instability the cause of "high" cervical ossified posterior longitudinal ligament? Analysis on the basis of surgical treatment of seven patients.
abstract: BACKGROUND
  Multilevel ossified posterior longitudinal ligaments (OPLLs), particularly those that extend into the high cervical region, are formidable and challenging surgical problems. The aim of the presentation is to analyze the results of surgical treatment of seven consecutive patients having high cervical OPLL with atlantoaxial and subaxial facetal fixations.
  
  
  OBJECTIVE
  We analyze the role of atlantoaxial instability in the management of OPLL that extended into the high cervical region, above the lower border of C3 vertebra.
  
  
  METHODS
  All patients in the series were males. The age of the patients ranged 48-65 years. Clinical evaluation was done by a 5-point clinical grading scale described by us, Japanese Orthopedic Association (JOA) score, and visual analog scale (VAS). All patients were identified to have relatively "subtle" but definite atlantoaxial facetal instability on sagittal imaging and the instability was confirmed by direct handling of the facets during surgery. All patients were treated by multilevel facetal fixation that included fixation of atlantoaxial facets. The aim of surgery was stabilization and arthrodesis of the involved spinal segments, as instability was considered to be the prime pathogenetic factor of OPLL. Spinal canal decompression, either by anterior corpectomy or discoidectomy or by posterior laminectomy or laminoplasty was not done and no attempts were made to remove the OPLL. At an average follow-up of 8 months, all patients showed progressive symptomatic recovery.
  
  
  CONCLUSIONS
  Atlantoaxial facetal instability can be a cause or an association of high cervical OPLL. Stabilization of the atlantoaxial joint forms a remarkably effective method of treatment.
authors.affiliation: Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital and Lilavati Hospital and Research Center, Bandra, Mumbai, Maharashtra, India.
authors.forename: Atul
authors.initials: A
authors.lastname: Goel
keywords: Atlantoaxial dislocation; atlantoaxial fixation; ossified posterior longitudinal ligament (OPLL); transarticular facetal fixation