Retrospective and prospective analysis of clinical, radiological and prognostic factors affecting surgical denouement in ossified posterior longitudinal ligament: an institutional experience

Rajesh R. Raykar, Guruprasad Bettaswamy, Rajesh Kumar Singh, Mahendra M.


Background: The most common cause of radiculopathy or myelopathy is “ossification of the posterior longitudinal ligament (OPLL)”. Surgical management consists of various anterior and posterior procedures. Anterior procedures done are corpectomy and fusion. Posterior procedures include laminectomy and laminectomy with fusion that include the use of lateral mass or pedicle screws with rods. Objective was to study the clinical course and to delineate clinico-radiological prognostic factors with regard to surgical outcome.

Methods: Patients operated for cervical OPLL were included. Detailed clinical history and radiological findings were retrospectively taken from the case records of the patients and prospectively recorded in the cases operated till May 2018. A minimum follow-up of 6 months was done for improvement. Preoperative clinical evaluation was done. Surgical options were individualized for each patient. Detailed clinical evaluation was done at discharge and at follow-up.

Results: It has been found that those patients who were admitted with Nurick’s myelopathy grade IV and V at admission, those with higher number of levels involved like 5, 6 and 7, those with duration of symptoms of more than one year were more likely to have same or deteriorated outcome compared to their counterparts. Other parameters were not found to be significantly associated with outcome.

Conclusions: Duration of symptoms >12 months, Sphincter disturbances were significant poor clinical prognostic markers. Significant poor radiological prognostic markers were segmental stenotic index <0.4, MRI T2-Weighted hyper intense signal change.


OPLL, Prognostic factors, Retrospective study, Surgical outcome

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