Advances in surgical strategies for ossification of posterior longitudinal ligament involving the C 2 segment / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C 2 segment.@*METHODS@#The literature about the surgery for cervical OPLL involving C 2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized.@*RESULTS@#For cervical OPLL involving the C 2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification.@*CONCLUSION@#OPLL involving the C 2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C 2 segment.

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.

Double-hook retractor for microlumbar discectomy and foraminotomy.

Aiming to achieve better results in microlumbar discectomy and foraminotomy, a double-hook retractor has been designed to retract lumbar paraspinal muscles away from the spinous process. A double-hook retractor obviates the limitations of single-hook systems.