Is Surgery Indicated for Asymptomatic or Mildly Myelopathic Patients With Significant Ossification of the Posterior Longitudinal Ligament?

In Brief Study Design. Review article. Objective. To discuss indications and timing of surgery for patients with significant ossification of the posterior longitudinal ligament (OPLL) who show no or only mild myelopathic symptoms. Summary of Background Data. Among patients with cervical spinal cord injury, the incidence of patients with OPLL is relatively high, and most had no obvious symptoms of cervical myelopathy. Methods. These topics were discussed on the basis of clinical practice guidelines for ossification of the posterior longitudinal ligament as published in 2005 by the Japanese Orthopaedic Association and the Committee on Research into OPLL under the auspices of the Ministry of Health, Labor and Welfare. Results. No evidence supports the usefulness of surgery for patients with significant OPLL without or with only mild cervical myelopathy. Conclusion. “Prophylactic” surgery for patients with significant OPLL without or with only mild cervical myelopathy cannot be recommended on the basis of the existing evidence. Indications and timing of surgery for patients with significant ossification of the posterior longitudinal ligament (OPLL) who show no or only mild symptoms of cervical myelopathy are discussed on the basis of clinical practice guidelines for OPLL as published in 2005 by the Japanese Orthopaedic Association.