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Hiroshi Abe, Mitsuo Tsuru, Terufumi Ito, Yoshinobu Iwasaki and Mitsuyuki Koiwa

S ince cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) was first reported by Tsukimoto 18 in 1960, the incidence of OPLL has been reported as increasing among the Japanese. Operative procedures for OPLL of the cervical spine are of two types, namely, the posterior approach and the anterior approach. We used the posterior approach in about 50 cases of OPLL until 1977. The results were generally satisfactory for the spinal cord signs, but sometimes the radicular signs did not improve. In addition, since ossification

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Chikao Nagashima, Motohide Takahama, Toshikatsu Shibata, Hiroaki Nakamura, Keiichi Okada, Hitoshi Morita and Hirokazu Kubo

/dl), and Cl 124 mEq/liter. Wassermann test of the CSF and serum was negative. X-ray films showed a developmental narrow canal, with an anteroposterior diameter of 16 mm at C-1, 14 mm at C-2, and 11 mm at C-3, C-4, and C-5. There was spondylotic osteoarthrosis of the C3–4 apophyseal joints with facet hypertrophy ( Fig. 9A ). Laminograms revealed a segmental type of ossification of the posterior longitudinal ligament (OPLL) behind the C-5 body, extending up along the protruded C4–5 disc ( Fig. 9B ), and a round dense shadow suggesting a calcified nodule between C3

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Toshihiko Kubota, Kazuhumi Sato, Hirokazu Kawano, Shinjiro Yamamoto, Asao Hirano and Yoshio Hashizume

O ssification of the posterior longitudinal ligament (OPLL) is a common disease of the spinal canal in Mongolians but an extremely rare one among Caucasians. 11 Since Tsukimoto 10 first described the histological findings in an autopsied case of OPLL in 1960, 10 this clinical entity has gradually become recognized, and the number of reported clinical cases have increased rapidly after 1970. 11 In 1974, the Investigation Committee on OPLL was appointed by the Ministry of Public Health and Welfare of Japan to perform systematic clinical and pathological

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Paul R. Cooper and Wendy Cohen

overriding facets 2 facet fracture 1 foramen transversarium fracture 1 Jefferson fracture 1 spinous process fracture 1 * As visualized on metrizamide myelography-computerized tomography scanning. TABLE 3 Incidence of spinal cord abnormalities * Lesion No. swollen spinal cord 6 lacerated spinal cord 2 osteophytic cord compression 2 complete subarachnoid block 1 compression from OPLL 1 epidural hematoma 1 disc herniation 1

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Kazuo Yonenobu, Sohei Ebara, Keiju Fujiwara, Kazuo Yamashita, Keiro Ono, Tomio Yamamoto, Norimasa Harada, Hiroshi Ogino and Shinzaburo Ojima

V arious diseases are known to produce hyperostosis or ossification of the ligament in the spine. 12 One of these, ankylosing spinal hyperostosis, is a well-known condition that occurs worldwide. It was described by Forestier and Rotes-Querol 2 in 1950. In Japan, patients with ankylosing spinal hyperostosis may also develop ossification of the posterior longitudinal ligament (OPLL) in the cervical spine, with serious accompanying neurological complications. Techniques for diagnosis and treatment of OPLL in the cervical spine have been evaluated in a

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Griffith R. Harsh IV, George W. Sypert, Philip R. Weinstein, Donald A. Ross and Charles B. Wilson

C ompression of the spinal cord by an ossified posterior longitudinal ligament (OPLL) was originally described in Guys Hospital Reports in 1838. 19 Since 1960, OPLL has been recognized as an important clinical entity among people of Japanese descent, 35, 37 and is frequently called “the Japanese disease.” 7 Recent reports in the Japanese orthopedic literature have emphasized both the prevalence in the Japanese population of about 2.0% and the value of axial computerized tomography (CT) for the diagnosis of OPLL. 38 The choice among surgical procedures

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Yasutaka Matsuda, Kazumi Miyazaki, Kenji Tada, Atsushi Yasuda, Tomitaka Nakayama, Hitoshi Murakami and Michimasa Matsuo

fusion. Their clinical condition was evaluated with the assessment scale proposed by the Japanese Orthopaedic Association (JOA) Scale ( Table 2 ). TABLE 1 Clinical and magnetic resonance imaging (MRI) findings in 29 patients with cervical myelopathy * Case No. Age (yrs), Sex JOA Score Diagnosis Duration of Myelopathy (mos) Type of Surgery MRI Level Increased Signal † Preop Postop Preop Postop 1 61, M 14 17 OPLL 50 Cloward C5–6 − − 2 49, F 13 17 herniation 6

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Deepak Awasthi and Rand M. Voorhies

A nterior cervical vertebrectomy with interbody fusion is one of the surgical procedures used for multilevel cervical disease, including cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL). 6, 7, 9, 16, 17 This report discusses our technique in performing this procedure using a high-speed drill and bone-bank fibular strut graft. This technique seeks to combine the relative safety of the Smith-Robinson operation with the improved exposure of the Cloward procedure. Its most frequent application is for multilevel cervical disease

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Christopher G. Paramore, Curtis A. Dickman and Volker K. H. Sonntag

C6–7 47, M C, 2 no NA no cervical spondylosis/myelopathy 71, M C, 1; yes 72 no postoperative instability D, 1 54, M C, 2 yes NA no postoperative instability 59, M C, 2 yes 66 yes postoperative instability 78, F C, 1 no 37 yes cervical spondylosis/myelopathy 72, M C, 2 no 88 yes OPLL 41, M C, 2 yes 54 yes postoperative instability 79, F C, 4 yes 72 yes postoperative laminectomy/kyphosis 65, F D, 1 no 28 yes

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Daniel M. May, Stephen J. Jones and H. Alan Crockard

patients because of the absence of measurable SSEPs. The etiological indication for surgery and the surgical pathology were diverse, as is shown in Table 1 . TABLE 1 Surgical pathology according to etiology in 191 procedures involving the cervical spine * Pathology (no. of procedures) Etiology BI SBM CS SLDD MLDD OPLL FSub MSub KD CRC no CRC Total congenital 12 3 4 2 3 2 4 30 traumatic 1 1 5 12 4 1 24 cervical spondylosis