Multilevel cervical oblique corpectomy in the treatment of ossified posterior longitudinal ligament in the presence of ossified anterior longitudinal ligament

Study Design. Clinical study. Objective. To highlight the value of the oblique corpectomy in managing patients with cervical myelopathy caused by extensive ossified posterior longitudinal ligament (OPLL) who also have a coexisting ossified anterior longitudinal ligament (OALL). Summary of Background Data. OPLL, OALL, and diffuse idiopathic skeletal hyperostosis ( DISH) may coexist, and the surgical treatment is varied. Patients with cervical myelopathy who are asymptomatic for the OALL may be managed by either anterior or posterior approaches, while those with dysphagia are best managed by an anterior approach that can deal with both pathologies simultaneously. The OALL resection is indicated only if symptomatic. The central corpectomy, while a good option for anterior decompression, requires complex reconstruction procedures. The oblique corpectomy preserves the ventral half of the vertebral body and does not require stabilization. Methods. In a series of 135 patients undergoing multilevel oblique corpectomy for cervical myelopathy, 3 had OPLL with massive OALL that was asymptomatic. The OPLL was removed using microdrills while preserving the OALL. Preoperative and postoperative MR imaging assessed cord compression and spinal alignment, whereas dynamic plain roentgenography assessed stability. Patients were assessed clinically for signs of dysphagia and dysphonia. Results. The cervical myelopathy improved in all 3 patients at a follow-up of 3 years, 1 year, and 6 months, respectively, with no development of dysphagia. One patient had a Horner's syndrome that improved by 6 months and another had a C5 radiculopathy that was improving by 6 months. Imaging showed good decompression of the spinal cord, with no kyphosis or instability. Conclusion. The oblique corpectomy is a surgical option in patients with asymptomatic OALL in the setting of progressive myelopathy due to OPLL with intrinsic stability as a result of their OALL. This technique avoids a multilevel central corpectomy that is associated with significant instability often requiring reconstructive procedures.