Posterior Decompression with Instrumented Fusion by Posterior Approach for Extensive Ossification of Posterior Longitudinal Ligament: A Report of Two Cases

Abstract

We describe 2 cases of posterior decompression with instrumented fusion by posterior approach for extensive ossification of the posterior longitudinal ligament and good short-term clinical results. Before surgery, patients were unable to stand up and walk independently. There OPLLs were large, beak-shaped, located at the top of the vertebral kyphosis, and T2 high intensity area indicated spinal cord damage at MRI. We performed posterior decompression with instrumented fusion by posterior approach, and combined one of these with the anterior decompression method via posterior approach reported by Otsuka in 1996. No perioparative complications occurred. The patients showed improvement of myelopathy after the operation and those who could not walk before surgery recovered the ability to walk independently or with a cane. Their average Japanese Orthopaedic Association Score for thoracic myelopathy (full score 11 points) improved from 6.0 points preoperatively to 8.5 points postoperatively. We concluded that posterior decompression with instrumented fusion by posterior approach is useful and that anterior decompression can be combined via a posterior approach in some cases with extensive ossification of the posterior longitudinal ligament.