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Progression of Cervical Ossification of Posterior Longitudinal Ligament After Laminoplasty or Laminectomy With Posterior Fixation

Kang, Moo Sung MD*,†; Kim, Kyung Hyun MD, PhD*; Park, Jeong Yoon MD, PhD*; Kuh, Sung Uk MD, PhD*; Chin, Dong Kyu MD, PhD*; Kim, Keun Su MD, PhD*; Jin, Byung Ho MD; Cho, Yong Eun MD, PhD*

doi: 10.1097/BSD.0000000000000898

Study Design: Retrospective case analysis.

Objective: This study was conducted to investigate the course of ossification of the posterior longitudinal ligament (OPLL) progression after laminoplasty (LP) or laminectomy with posterior fixation (PF).

Summary of Background Data: LP is now recognized as a standard technique for the treatment of cervical multisegment OPLL; however, PF is beneficial for patients with severe stenosis. In recent years, there has been increasing interest in mechanical stress in OPLL, which is assumed to significantly impact progression.

Methods: The progression of OPLL was assessed using midline sagittal computed tomography images of the cervical spine at various follow-up points. Radiographic parameters including the C2–C7 Cobb angle, C2–C7 range of motion (ROM), and adjacent cranial and caudal segmental ROMs were measured. Postoperative changes and differences between the LP and PF groups in the radiographic parameters were calculated to assess biomechanical stress. Logistic regression analysis was used to analyze the risk factors affecting the progression rate.

Results: The authors included 14 PF and 36 LP patients, with a mean follow-up period of 28.9±20.8 and 37.6±16.8 months, respectively (P=0.069). After surgical treatment, both groups showed loss of cervical lordosis (9.2±6.9 vs. 5.3±8.2 degrees, P=0.220) and C2–C7 ROM (14.6± 13.5 vs. 13.1±12.2 degrees, P=0.861). The decrease of ROM in the cranial adjacent segment was larger in the LP group than in the PF group (0.7±4.1 vs. 1.4±5.5 degrees, P=0.453). The ROM in the caudal adjacent segment decreased in the LP group but increased in the PF group (−1.4±6.2 vs. 2.6±5.1 degrees, P=0.041). The progression rate was 2.15±1.31 mm2/mo in the PF group and 1.53±1.04 mm2/mo in the LP group (P=0.041). PF showed an odds ratio of 12.917 for a higher progression rate (95% confidence interval, 1.397–119.443; P=0.024).

Conclusion: The rate of progression of cervical OPLL was significantly higher after PF than after LP.

Level of Evidence:

Level III—a retrospective analysis.

*Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul

Department of Neurosurgery, Catholic Kwandong University, International St. Mary’s Hospital, Incheon, South Korea

This report has not been published in any kinds of literature yet.

The authors declare no conflict of interest.

Reprints: Yong Eun Cho, MD, PhD, Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonjuro Gangnam-gu, Seoul 135-720, Korea (e-mail:

Received May 20, 2019

Accepted August 17, 2019

Online date: September 27, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.