NDLI: Cervical myelopathy in patients with ossification of the posterior longitudinal ligament.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Mochizuki, Macondo Aiba, Atsuomi Hashimoto, Mitsuhiro Fujiyoshi, Takayuki Yamazaki, Masashi
Description	Country affiliation: Japan Author Affiliation: Mochizuki M ( Department of Orthopaedic Surgery, Numazu City Hospital, Shizuoka, Japan.)
Abstract	OBJECT: The authors assessed the clinical course in patients with a narrowed cervical spinal canal caused by ossification of the posterior longitudinal ligament (OPLL), but who have no or only mild myelopathy. Additionally, the authors analyzed the factors contributing to the development and aggravation of myelopathy in patients with OPLLinduced spinal canal stenosis. METHODS: Between 1997 and 2004, the authors selected treatments for patients with cervical OPLL in whom the residual space available for the spinal cord was < or = 12 mm. Treatment decisions were based on the severity of myelopathy at presentation. Twenty-one patients with no or mild myelopathy (defined as a Japanese Orthopaedic Association [JOA] scale score > or = 14 points) received conservative treatment, with a mean follow-up period of 4.5 years. In 20 patients with moderate or severe myelopathy (JOA scale score < 14 points), the authors performed surgery via an anterior approach. The clinical course in these patients was assessed with the JOA scale and the OPLL types were classified. The authors evaluated the range of motion between C-1 and C-7, the developmental segmental sagittal diameter, the percentage of spinal canal diameter occupied by the OPLL (% ratio), and the residual space available for the spinal cord on cervical radiographs; T2-weighted MR images were examined for high signal changes (HSCs). RESULTS: In the conservative treatment group, 8 patients showed improvement, 12 remained unchanged, and 1 patient's condition became slightly worse during the observation period. Fifteen patients in this group had mixedtype, 3 had continuous-type, 2 had localized-type, and 1 had a segmental-type OPLL. In the surgically treated group, there were 12 patients with segmental-type, 10 patients with mixed-type, and 1 with localized-type OPLL. The mean range of motion at C1-7 was 36.4 degrees in the conservatively treated group and 46.5 degrees in the surgical group (p < 0.05). No significant difference was seen between the groups in terms of developmental segmental sagittal diameter, % ratio, or residual space available for the cord. No HSCs were noted in the conservative group, while 17 patients in the surgical group had HSCs (p < 0.05). CONCLUSIONS: In the present study, the authors demonstrate that the mobility of the cervical spine and the type of OPLL are important factors contributing to the development and aggravation of myelopathy in patients with OPLLinduced spinal canal stenosis. The authors advocate conservative treatment in most patients with OPLLs who have no or only mild myelopathy, even in the presence of spinal canal narrowing.
File Format	HTM / HTML
ISSN	15475654
Issue Number	2
Volume Number	10
e-ISSN	15475646
Journal	Journal of Neurosurgery: Spine
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2009-02-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Neurosurgery Cervical Vertebrae Decompression, Surgical Ossification Of Posterior Longitudinal Ligament Surgery Spinal Cord Compression Etiology Therapy Spinal Stenosis Adult Aged Female Follow-up Studies Humans Male Middle Aged Complications Pathology Range Of Motion, Articular Treatment Outcome Case Reports Journal Article
Content Type	Text
Resource Type	Case study Article
Subject	Neurology Neurology (clinical) Surgery

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