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A Patient With Two Re-surgeries for Delayed Myelopathy Due to Progression of Ossification of the Posterior Longitudinal Ligaments After Cervical Laminoplasty

Tokuhashi, Yasuaki, MD; Ajiro, Yasumitsu, MD; Umezawa, Natsuki, MD

doi: 10.1097/BRS.0b013e31818a3135
Case Reports
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Study Design. Case report.

Objective. To discuss the development of delayed myelopathy due to the progression of ossification of the posterior longitudinal ligament (OPLL) after cervical laminoplasty.

Summary of Background Data. The progression of OPLL after cervical laminoplasty for the treatment of OPLL is often shown in long-term follow-up; however, few patients with reoperation due to OPLL progression have been reported.

Methods. The patient was a 70-year-old male carpenter. At 57-years of age, he underwent open door laminoplasty between C3 and C7 with dome-like laminectomy of C2 for the treatment of myelopathy due to mixed-type OPLL (continuous type at C3–C4 and segmental type at C5). Five years after the initial surgery, the disorder of skilled motor activity in the bilateral hands and ambulatory difficulties recurred as a result of cranial progression of OPLL (between C2 and C4). He underwent laminectomy and posterior fusion between C2 and C5 and returned to work. Four years after resurgery, the same symptoms recurred.

Results. CT revealed the progression of OPLL thickness at C5 level and longitudinal progression of OPLL to C6/7. Sagittal view of MRI demonstrated spinal cord compression between C5 and C6/7 because of OPLL at C5 and hypertrophic ligamentum flavum at C5–C6 and C6–C7. Posterior fusion extending up to C7 with laminectomy of C6 and C7 was performed. His symptoms were alleviated and he could walk again.

Conclusion. We reported a patient with OPLL who had undergone resurgery twice because of myelopathy due to the progression of ossification. It was important to establish a sufficiently longitudinal and transverse decompression, taking the risk of the unexpected progression of ossification into consideration.

A patient with ossification of the posterior longitudinal ligament who had undergone re-surgery twice because of myelopathy, due to the progression of ossification after cervical laminoplasty was reported. Local increases in the range of intervertebral motion were most likely to have induced the progression of ossification of the posterior longitudinal ligament.

From the Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo, Japan.

Acknowledgment date: April 2, 2008. First revision date: July 13, 2008. Acceptance date: July 25, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Yasuaki Tokuhashi, MD, Department of Orthopedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610 Japan; E-mail ytoku@med.nihon-u.ac.jp

© 2009 Lippincott Williams & Wilkins, Inc.