Anterior cervical decompression and fusion using carbon dioxide (CO/sub 2/) laser attached to surgical microscope in treatment of cervical ossification posterior longitudinal ligament

The ossification of the posterior longitudinal ligament (OPLL) appears as an abnormal high density along the posterior margin of the vertebral bodies on lateral views of the roentgenogram. The cause of ossification of the posterior longitudinal ligament remains obscure. Systemic factors, including abnormal glucose and calcium metabolism and hormonal disturbance, genetic predisposition to ossification, aging, and local factors such as degenerative change of intervertebral disc, instability and anatomic site, have been proposed. Radiologic evidence of ossification of the posterior longitudinal ligament in the cervical spine was found in 3.2% of the asymptomatic Japanese population of more than 50 years of age and the reported detection of ossification of the posterior longitudinal ligament in whites was 0.36% in North America and 1.7% in Italy. In patients who are frankly myelopathic, ossification of the posterior longitudinal ligament is the primary contributing factor in 27% of Japanese and 20-25% of North Americans so it is necessary to establish guide line for surgical treatments. Comparison of a follow-up study of anterior and posterior surgery for cervical ossification of the posterior longitudinal ligament is difficult because the surgical techniques used in the anterior and posterior approach has been changed over times, and the clinical data is not uniform. We think initial complete extirpation of extensive ossification of the posterior longitudinal ligament masses and long fusion with various type of fusion graft is the best treatment for cervical ossification of the posterior longitudinal ligament.