1997 年 11 巻 1 号 p. 39-46
Although there has been a long debate whether ossification of the posterior longitudinal ligament (OPLL) of the cervical spine should be treated anteriorly or posteriorly, direct removal of the ossified mass for relieving cord compression by the anterior approach is widely considered as the most suitable surgical treatment. The authors present their surgical experience of anterior decompression of OPLL. Among 119 cases (121 operations) of cervical OPLL treated with anterior medial corpectomy and direct removal of OPLL, 60 cases were treated with iliac graft, one with fibula graft and 58 recent cases of mostly segmental OPLL were treated with autogenous vertebral bone graft to avoid the use of halo brace and discomfort in the iliac donor site. As for the operative results, 60(51%) were excellent, 44(38%) good and 13(11%) fair. There was a significant correlation between the operative results and the preoperative severity of myelopathy. However, no such correlation was found between the operative results and the number of the affected level. Regarding complications, dural defect with cerebrospinal fluid leakage occurred in 22 cases (18%), in which lumbar drainage was required only in 8 cases. Other complications including dislocation of the grafted bone in 7 cases, root injury in 3, but no cord injury was noted. Anterior approach is a reasonably safe and effective method with few major complications. Autogenous vertebral graft avoids halo brace and pain in the donor site, and it helps patients achieve early rehabilitation when the anterior approach is chosen in segmental OPLL of the cervical spine with discs and spurs.