Anterior decompressive surgery after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament

Background context: Two surgical procedures, posterior decompressive surgery (PDS) and anterior decompressive surgery (ADS), are the treatment options for cervical ossification of the posterior longitudinal ligament (OPLL). Each procedure has advantages and disadvantages. Cervical laminoplasty, a type of PDS, is relatively easy to perform and can be used for patients with multilevel cord compression. ADS can often be more technically demanding.

Objective: The purpose of this study was to clarify the clinical characteristics and surgical results of the patients for whom ADS was necessary after PDS.

Study design: Retrospective study.

Methods: A total of 144 patients, followed for more than 3 years after cervical laminoplasty, were included. The neurologic status was graded using the Japanese Orthopedic Association (JOA score). Eleven patients underwent ADS after PDS. The clinical background and surgical outcomes were evaluated. Radiological findings of the 11 patients requiring ADS after PDS (PA group) and the 133 PDS patients not requiring ADS (P group) were compared.

Results: In the PA group, the JOA score was slightly deteriorated during follow-up after cervical laminoplasty. Severe pain in the unilateral upper extremity and deterioration of cervical myelopathy were the most typical symptoms necessitating ADS. The incidence of the mixed type of OPLL was significantly higher in this group. The JOA score improved in all patients after ADS as a second surgery.

Conclusions: In our strategy for the surgical treatment of cervical OPLL, PDS with laminoplasty remains as the initial treatment, and in patients with neurological deterioration and newly developed clinical symptoms during follow-up, ADS is considered as a salvage procedure.