The Journal of Bone and Joint Surgery (American). 2005;87:610-615.
doi:10.2106/JBJS.C.01711
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the exams for this article:
 Spine Test 7: Spring 2005
CME 1: January, February, March 2005
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Belanger, T. A.
Right arrow Articles by Bohlman, H. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Belanger, T. A.
Right arrow Articles by Bohlman, H. H.
Related Collections
Right arrow Spine
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Ossification of the Posterior Longitudinal Ligament

Results of Anterior Cervical Decompression and Arthrodesis in Sixty-one North American Patients

Theodore A. Belanger, MD1, Jeffrey S. Roh, MD2, Stephen E. Hanks, MD3, James D. Kang, MD4, Sanford E. Emery, MD, MBA5 and Henry H. Bohlman, MD2

1 Miller Orthopaedic Clinic, 1001 Blythe Boulevard, Suite 200, Charlotte, NC 28203. E-mail address: ted.belanger{at}millerclinic.com
2 University Hospitals Spine Institute and the Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106.
3 University of Arizona Health Sciences Center, P.O. Box 245064, Tucson, AZ 85719. E-mail address: sehanks{at}email.arizona.edu
4 University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 1010, Pittsburgh, PA 15213. E-mail address: kangjd{at}upmc.edu
5 Robert C. Byrd Health Sciences Center, Box 9196, Morgantown, WV 26506. E-mail address: semery{at}hsc.wvu.edu

Investigation performed at University Hospital Spine Institute, Case Western Reserve University, Cleveland, Ohio

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Medtronic Sofamor Danek. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Ossification of the posterior longitudinal ligament is commonly associated with cervical myelopathy. Surgical treatment is a matter of controversy. We report on a series of patients who were managed with anterior cervical decompression and arthrodesis for the treatment of cervical myelopathy associated with ossification of the posterior longitudinal ligament.

Methods: We retrospectively reviewed the records for all sixty-five patients who had been managed with anterior decompression and arthrodesis for the treatment of cervical ossification of the posterior longitudinal ligament and associated neurologic compression from 1982 to 2001. Sixty-one patients (thirty-nine men and twenty-two women) were followed for at least two years (or until the time of death). The average number of vertebrae resected was 2.2. The average duration of follow-up for the sixty surviving patients was four years (range, two years to fifteen years and four months). The preoperative, six-week postoperative, and final follow-up clinical status (including neurological function as assessed with the Nurick grading system) was recorded for each patient.

Results: Fifty-six of the sixty-one patients had neurological improvement, with an average improvement of 1.5 Nurick grades at the time of the final follow-up. Eight patients had absent dura at the time of surgery and, of these, five had development of a cerebrospinal fluid fistula. Eight patients had development of new neurological signs and/or symptoms in the upper extremity postoperatively. Eight patients required reoperation because of a painful pseudarthrosis (one patient), strut-graft dislodgment (three), cerebrospinal fluid leakage (three), or compression of a nerve root caudad to the area of the original procedure (one). One patient died as the result of cardiac arrest on the third postoperative day. Fifty-eight patients had an osseous fusion, one had an asymptomatic nonunion, and one had a symptomatic pseudarthrosis that was treated with revision surgery.

Conclusions: Anterior decompression and arthrodesis is an effective way to achieve pain relief and neurological improvement in North American patients of non-Asian descent who have cervical myelopathy associated with ossification of the posterior longitudinal ligament. The risk of durocutaneous fistula, graft dislodgment, and postoperative neurological symptoms appears to be high in patients with cervical myelopathy associated with this condition.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
D. Hannallah, J. Lee, M. Khan, W. F. Donaldson, and J. D. Kang
Cerebrospinal Fluid Leaks Following Cervical Spine Surgery
J. Bone Joint Surg. Am., May 1, 2008; 90(5): 1101 - 1105.
[Abstract] [Full Text] [PDF]