Cervical Myelopathy Associated with Degenerative Spine Disease and Ossification of the Posterior Longitudinal Ligament

ABSTRACT

Cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament are two of the leading etiologies of spinal cord damage in older patients. For most patients, the natural history is one of slow stepwise decline in function. With nonsurgical therapy only 30 to 50% of patients are expected to stabilize. Surgical options include anterior and posterior surgical decompression, spinal canal expansion, and spinal column stabilization. Prospective, randomized trials with standardized outcome measures are needed to clarify the benefit of surgery conclusively.

KEYWORDS

Cervical myelopathy - ossification of the posterior longitudinal ligament - cervical spondylotic myelopathy - surgery

REFERENCES

• 1 Gore D R, Sepic S B, Gardner G M. Roentgenographic findings of the cervical spine in asymptomatic people.  Spine . 1986;  11 521-524
• 2 Koyanagi I, Iwasaki Y, Hida K, Imamura H, Abe H. Magnetic resonance imaging findings in ossification of the posterior longitudinal ligament of the cervical spine.  J Neurosurg . 1998;  88 247-254
• 3 Kurata A, Tokiwa K, Kitahara I. [Myelopathy caused by hypertrophy of the posterior longitudinal ligament (HPLL): case report].  No Shinkei Geka Neurol Surg. 1987;  15 651-655
• 4 Harsh G RT, Sypert G W, Weinstein P R, Ross D A, Wilson C B. Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament.  J Neurosurg. 1987;  67 349-357
• 5 Burrows H. The sagittal diameter of the spinal canal in cervical spondylosis.  Clin Radiol . 1963;  14 77-88
• 6 Adams C B, Logue V. Studies in cervical spondylotic myelopathy: II. The movement and contour of the spine in relation to the neural complications of cervical spondylosis.  Brain . 1971;  94 568-586
• 7 Cusick J F. Pathophysiology and treatment of cervical spondylotic myelopathy.  Clin Neurosurg . 1991;  37 661-681
• 8 Edwards W C, LaRocca H. The developmental segmental sagittal diameter of the cervical spinal canal in patients with cervical spondylosis.  Spine . 1983;  8 20-27
• 9 Yue W M, Tan S B, Tan M H, Koh D C, Tan C T. The Torg-Pavlov ratio in cervical spondylotic myelopathy: a comparative study between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population.  Spine . 2001;  26 1760-1764
• 10 Hukuda S, Wilson C B. Experimental cervical myelopathy: effects of compression and ischemia on the canine cervical cord.  J Neurosurg . 1972;  37 631-652
• 11 Taylor A. Vascular factors in the myelopathy associated with cervical spondylosis.  Neurology . 1964;  14 62-68
• 12 Clifton A G, Stevens J M, Whitear P, Kendall B E. Identifiable causes for poor outcome in surgery for cervical spondylosis: post-operative computed myelography and MR imaging.  Neuroradiology . 1990;  32 450-455
• 13 Phillips D G. Surgical treatment of myelopathy with cervical spondylosis.  J Neurol Neurosurg Psychiatry . 1973;  36 879-884
• 14 Reale F. Long-term results in 102 cases of cervical myeloradiculopathy operated on for spondylosis and disc herniation.  Ital J Neurol Sci . 1983;  4 291-296
• 15 Signorini G C, Beltramello A, Pinna G, Dalle Ore G. The significance of preoperative neurological disorders in predicting outcome of cervical spondylotic myelopathy after surgery.  J Neurosurg Sci . 1984;  28 89-92
• 16 Teresi L M, Lufkin R B, Reicher M A. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging.  Radiology . 1987;  164 83-88
• 17 Clarke E, Robinson P. Cervical myelopathy: a complication of cervical spondylosis.  Brain . 1956;  79 483-510
• 18 Lees F, Turner J. Natural history and prognosis of cervical spondylosis.  Br Med J . 1963;  2 1607-1610
• 19 Nurick S. The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis.  Brain . 1972;  95 101-108
• 20 Symon L, Lavender P. The surgical treatment of cervical spondylotic myelopathy.  Neurology . 1967;  17 117-127
• 21 LaRocca H. Cervical spondylotic myelopathy: natural history.  Spine . 1988;  13 854-855
• 22 Carol M P, Ducker T B. Cervical spondylitic myelopathies: surgical treatment.  J Spinal Disord . 1988;  1 59-65
• 23 Teramoto T, Ohmori K, Takatsu T. Long-term results of the anterior cervical spondylodesis.  Neurosurgery . 1994;  35 64-68
• 24 Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K. Laminoplasty versus subtotal corpectomy: a comparative study of results in multisegmental cervical spondylotic myelopathy.  Spine . 1992;  17 1281-1284
• 25 Sampath P, Bendebba M, Davis J D, Ducker T B. Outcome of patients treated for cervical myelopathy: a prospective, multicenter study with independent clinical review.  Spine . 2000;  25 670-676
• 26 Cusick J F, Yoganandan N, Pintar F, Myklebust J, Hussain H. Biomechanics of cervical spine facetectomy and fixation techniques.  Spine . 1988;  13 808-812
• 27 Cusick J F, Pintar F A, Yoganandan N. Biomechanical alterations induced by multilevel cervical laminectomy.  Spine . 1995;  20 2392-2398
• 28 Benzel E. Cervical spondylotic myelopathy: posterior surgical approaches. In: Menezes A, Sonntag V, Benzel E, Cahill D, McCormick P, Papadopoulos S, eds. Principles of Spinal Surgery Vol. 1. New York: McGraw-Hill 1996: 571-580
• 29 Hirabayashi K, Satomi K. Operative procedure and results of expansive open-door laminoplasty.  Spine . 1988;  13 870-876
• 30 Itoh T, Tsuji H. Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine.  Spine . 1985;  10 729-736
• 31 Tanaka J, Seki N, Tokimura F, Doi K, Inoue S. Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients.  Spine . 1999;  24 2308-2312
• 32 Shimamura T, Kato S, Toba T, Yamazaki K, Ehara S. Sagittal splitting laminoplasty for spinal canal enlargement for ossification of the spinal ligaments (OPLL and OLF).  Semin Musculoskeletal Radiol . 2001;  5 203-206
• 33 Wada E, Suzuki S, Kanazawa A. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years.  Spine . 2001;  26 1443-1447
• 34 Lowery G L, McDonough R F. The significance of hardware failure in anterior cervical plate fixation: patients with 2- to 7-year follow-up.  Spine . 1998;  23 181-186
• 35 Onari K, Akiyama N, Kondo S. Long-term follow-up results of anterior interbody fusion applied for cervical myelopathy due to ossification of the posterior longitudinal ligament.  Spine . 2001;  26 488-493
• 36 Abe H, Tsuru M, Ito T, Iwasaki Y, Koiwa M. Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine.  J Neurosurg . 1981;  55 108-116
• 37 Kojima T, Waga S, Kubo Y. Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament.  Neurosurgery . 1989;  24 864-872
• 38 Zdeblick T A, Bohlman H H. Cervical kyphosis and myelopathy: treatment by anterior corpectomy and strut-grafting.  J Bone Joint Surg Am . 1989;  71 170-182
• 39 Fernyhough J C, White J I, LaRocca H. Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients.  Spine . 1991;  16(suppl 10) S561-S564
• 40 Mizuno J, Nakagawa H. Outcome analysis of anterior decompressive surgery and fusion for cervical ossification of the posterior longitudinal ligament: report of 107 cases and review of literature.  Neurosurg Focus . 2001;  10 1-7
• 41 Epstein J E, Epstein N E. The surgical management of cervical spinal stenosis, spondylosis and myeloradiculopathy by means of the posterior approach. In: Sherk H, Dunn E, Eismont F, eds. The Cervical Spine 2nd ed. Philadelphia: JB Lippincott 1989: 625-643
• 42 Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K. Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy.  Spine . 2001;  26 1890-1894