Limited oblique corpectomy for treatment of ossified posterior longitudinal ligament.

OBJECTIVE: We present our experience with treating four cases with ossified posterior longitudinal ligaments (OPLL) causing cervical cord compression by limited oblique and strategic corpectomy. MATERIALS AND RESULTS: Four patients with cervical OPLL were treated by the discussed technique during the period of October 2000 to January 2005. The ages of the patients ranged from 46 to 72 years. All patients presented with symptoms of progressively increasing myelopathy. Two patients had four level OPLL and two patients had two level OPLL. Surgery involved anterior cervical exposure and partial oblique corpectomy, which was essentially an extended midline and lateral undercutting of the body. The procedure provided a wide exposure for resection of the OPLL. No metal instrumentation or any other kind of fixation procedure was simultaneously carried out and there was no need for postoperative cervical immobilization. During the period of follow up that ranged from 6 month to 5 years (mean: 33 months) all the four patients have shown sustained clinical improvement. Neuroimaging studies confirmed satisfactory anatomical cervical cord decompression in all patients. CONCLUSIONS: The technique of oblique and strategic corpectomy provided a wide exposure for resection of the OPLL and preserved the stability of the region.

Atlantoaxial joint distraction for treatment of basilar invagination secondary to rheumatoid arthritis.

We present our experience of treating two cases of rheumatoid arthritis involving the craniovertebral junction and having marked basilar invagination by an alternative treatment method. In both the cases, the facets were osteoporotic and were not suitable for screw implantation. The patients were 66 and 72 years of age and both patients were females. Both the patients presented with complaints of progressively increasing spastic quadriparesis. Surgery involved attempts to reduce the basilar invagination and restore the height of the 'collapsed' lateral mass by manual distraction of the facets of the atlas and axis and forced impaction of titanium spacers in the joint in addition to bone graft harvested from the iliac crest. The procedure also provided stabilization of the region. No other fixation procedure involving wires, screws, plate and rods was carried out simultaneously. Following surgery both the patients showed symptomatic improvement and partial restoration of craniovertebral alignments. Follow-up is of 2 and 24 months. Distraction of the facets of atlas and axis and impaction of metal implant and bone graft in the facet joint can assist in reduction of basilar invagination and fixation of the region in selected cases of rheumatoid arthritis involving the craniovertebral junction.