Laser-assisted microsurgical techniques for the treatment of cervical ossification of the posterior longitudinal ligament
Sang-Ho Lee, Seokmin Choi
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
Keywords: Carbon dioxide; cervical vertebrae/surgery; lasers/ therapeutic use; ossification of posterior longitudinal ligament/ surgery; spinal fusion/methods; spine/surgery.
Objectives: Ossification of the posterior longitudinal ligament (OPLL) is one of the common causes of cervical myelopathy in Asian countries. The purpose of this study was to evaluate the efficacy of CO2 laser assisted microsurgical corpectomy in the treatment of cervical OPLL.
Patients and methods: We retrospectively reviewed the medical records and radiologic images of 47 patients (36 males, 11 females; mean age 54.7 years; range 41 to 70 years) who underwent microsurgical corpectomy and fusion with the use of CO2 laser for cervical OPLL. Control examinations were made after 1, 3, and 6 months and then, every six months postoperatively. Functional outcome following surgery was assessed according to the Nurick scale. The mean follow-up period was 22.7 months (range 16 to 44 months).
Results: All the patients demonstrated symptomatic improvement postoperatively. Thirty-three patients (70.2%) showed improvement of at least 1 Nurick grade at the final examination. None of the patients developed neurological deterioration. Two patients had cerebrospinal fluid leaks and one patient had transient hoarseness. Two patients underwent reoperation due to plate pullout accompanied by a screw fracture and progressive displacement of the graft, respectively. Forty two patients (89.4%) showed successful fusion. Five patients were determined to have a stable fibrous union.
Conclusion: Removal of cervical OPLL using the anterior route is quite different from that of cervical spondylosis in many aspects. Laser-assisted microsurgical techniques enable safe removal of cervical OPLL using the anterior route.