Head Jeffery, Rymarczuk George, Stricsek Geoffrey, Velagapudi Lohit, Maulucci Christopher, Hoelscher Christian, Harrop James
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
Neurospine. 2019 Sep;16(3):517-529. doi: 10.14245/ns.1938222.111. Epub 2019 Sep 30.
Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.
后纵韧带骨化（OPLL）是一种罕见但可能导致严重后果的退行性颈椎病（DCM）病因。减压手术是OPLL的标准治疗方法，可通过颈椎前路、后路或联合入路实现。通过任何入路对OPLL进行手术矫正都与较高的并发症发生率相关，并且OPLL的存在被认为是DCM手术围手术期并发症的重要危险因素。潜在并发症包括硬脑膜撕裂（DT）及随后的脑脊液漏、C5麻痹、血肿、内固定失败、手术部位感染和其他神经功能缺损。前路手术技术要求更高，DT发生率更高，但能更好地处理腹侧OPLL病变。后路手术并发症发生率较低，但可能会使疾病持续进展。因此，选择前路还是后路进行手术减压可能会受到每种手术相关并发症的严重影响。作者对OPLL手术减压的前路和后路方法进行了批判性综述，特别关注每种方法相关的并发症。我们还回顾了最近为OPLL开发新手术治疗方法的工作，这些方法旨在降低并发症发生率。
