4/18/2024 0 Comments Cervical spine torn ligament x ray![]() Complications include implant failure, non-union, and graft dislodgment which occur at an unacceptable incidence of 17–45% according to different studies. However, problems arise when more than two levels are involved and the anterior approach is associated with higher rates and unpredictable complications. Generally speaking, anterior decompression with fusion and instrumentation has been deemed suitable for cervical myelopathy involving 1–2 levels with low incidence of complications. We included only articles that specifically differentiated OPLL and other causes of DCM like CSM in this review. In this narrative review, we will highlight the differences in the techniques currently used and their respective advantages and disadvantages with respect to OPLL and other causes of DCM separately as they are different pathologies, and to suggest current recommendations and insights. We believe that the entity of OPLL may be different from the rest of pathologies within DCM. There has long been debate on the best approach for cervical myelopathy especially for multi-level compression. Surgical decompression may be achieved via anterior or posterior approaches and is unclear when either method is more suitable or preferred. It is believed that 75% of cases progress in a step-wise manner, 20% deteriorate slowly and 5% have rapid onset of symptoms, and thus the majority will need surgical treatment. Its natural history is usually progressive resulting in worsening disability and progressive limitation in function. ![]() Clumsiness and sensory deficits may lead to functional difficulties including buttoning, picking up small objects and using chopsticks. Patients with cervical myelopathy presents with weakness in the extremities, gait imbalance, abnormal reflexes, and clumsiness. These along with degenerative disc disease constitutes various non-traumatic and degenerative forms of cervical myelopathy and are commonly recognized under the umbrella term of degenerative cervical myelopathy (DCM). These ossification disorders are more common in Asians and may progress more aggressively. Ossification of the posterior longitudinal ligament (OPLL) is also an important pathology. Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction which occurs in the elderly and most commonly affects C5–6, followed by C6–7 and C4–5. Prolonged compression of the spinal cord eventually leads to grey matter atrophy and cell body degeneration which results in neurological symptoms. In those with congenital narrowing, a minor degree of additional pathology such as disc protrusion may already lead to symptoms. This narrowing may be congenital or acquired or both. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.Ĭervical myelopathy is a dysfunction of the spinal cord and is often caused by a narrowing of the cervical spinal canal. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio 60% for OPLL patients. ![]() Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Main body of the abstractĪ narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. ![]()
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