Myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) combined with ossification of the yellow ligament (OYL) at the same level is not rare, but surgical management of this lesion is controversial. We reported four cases and reviewed the literature on surgical therapy.
Case 1 : A 42-year-old man developed severe transverse cord syndrome up to T3, with a Japanese Orthopaedic Association (JOA) score of 3. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated OPLL and OYL in the upper and middle thoracic spine. Laminectomy of T2, 3, and 4 were performed. Post-op 6 month JOA score recovery rate (RR) was 25.0%.
Case 2 : A 48-year-old man developed severe transverse cord syndrome up to T5 with a JOA score of 6. CT and MRI demonstrated OPLL and OYL in the middle thoracic spine. Laminectomy of T4-5 was performed. Post-op 6 months RR was 44.4%.
Case 3 : A 67-year-old woman developed severe transverse and Brown-Séquard type myelopathy up to T5, JOA score of 6. CT and MRI demonstrated OPLL and OYL in the middle thoracic spine. Laminectomy of T3-4 and laminoplasty for T5, 6, and 7 were performed. Post-op 6 months RR was 60.0%. Kyphosis deteriorated.
Case 4 : A 45-year-old woman developed severe transverse and Brown-Séquard type myelopathy up to T3, JOA score of 5. CT and MRI demonstrated OPLL and OYL in the upper and middle thoracic spine, respectively. Laminoplasty for T3, 4, 5 and posterior lateral fixation (PLF) for T5/6/7 were performed. Post-op 6 months RR was 85.7%.
The ossificaion-kyphosis angle was useful in deciding the operative indication. One-staged posterior decompression and fixation should be considered in patients with long lesions and kyphosis. Careful long-term follow-ups are necessary.
