Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine

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✓ Anterior decompression and fusion for treating ossification of the posterior longitudinal ligament of the cervical spine was performed in 12 patients. The central part of the vertebral body and the ossified area of the posterior longitudinal ligament were removed by means of a microrongeur and an air drill. The defect was filled with a long bone graft taken from the ilium. The operative results were excellent. Marked improvement of radicular and spinal cord signs was seen in all 12 cases. Three vertebral bodies were fused in one case, four in nine cases, and five in two cases. The highest level of fusion was C-2 and the lowest was T-1. It is considered that any ossification of the ligament below the C-2 level can be removed via an anterior approach as long as no more than five vertebral bodies are involved. Spinal computerized tomography was valuable in providing more detailed information about the stenotic spinal canal and the shape of the ossified ligament.

Article Information

Address reprint requests to: Hiroshi Abe, M.D., Department of Neurosurgery, University of Hokkaido School of Medicine, North 15, West 7, Sapporo, Hokkaido, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Percentage narrowing of the spinal canal (anteroposterior) diameter. A = spinal canal diameter, and B = the diameter of the ossified ligament at the level of greatest canal narrowing.

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    Left: Resection of the central part of the vertebral bodies. Right: Removal of the ossified ligament.

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    Transverse section (upper) and lateral views (lower) of the spine. Left: Ossified ligament (cross-hatched area) and vertebral bodies are removed along the dotted lines. Right: Anterior vertebral body fusion with the iliac bone.

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    Diagram showing preparation of the iliac bone graft. The portion designated “A” is replaced into the ilium to avoid deformity, and the section designated “B” is used for the bone graft.

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    Case 9. Intraoperative photographs showing the ossified ligament at C5–7 (left) and the anterior vertebral body fusion with the iliac bone (right).

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    Operative results in 12 patients. Open circles indicate the preoperative status, closed circles the postoperative status. Neurological signs are designated as severe (+++) to absent (−).

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    Improvement of spinal cord signs related to spinal cord narrowing

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    Case 3. Left: Preoperative tomogram showing the ossified ligament at C4–6. Right: Tomogram 3 months after the operation. The ossified ligament was removed and anterior fusion was carried out from C-3 to C-7.

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    Case 4. Left: Preoperative tomogram showing the ossified ligament at C4–6. Right: Postoperative tomogram. The ossified ligament has been removed and anterior fusion has been carried out from C-3 to C-6.

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    Case 6. Left: Preoperative tomogram showing the ossified ligament at C3–5. Right: Tomogram performed 1 year after the ossified ligament was removed completely and anterior body fusion was carried out from C-2 to C-5.

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    Case 11. Left: Spinal computerized tomography scan demonstrating the ossified ligament at C-7. Right: Scan 3 months after the operation.

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