Surgical Treatment of Ossifications of the Cervical Anterior Longitudinal Ligament: A Retrospective Cohort Study

Global Spine J. 2020 May 19;2192568220922195. doi: 10.1177/2192568220922195. Online ahead of print.

Alexander von Glinski, Ariel Takayanagi, Christopher Elia, Basem Ishak, Mishan Listmann, Clifford A Pierre, Ronen Blecher, Erik Hayman, Jens R Chapman, Rod J Oskouian

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Abstract

Study design: Retrospective cohort study.

Objectives: The study aims to evaluate anterior cervical discectomy and fusion (ACDF) in the treatment of patients with ossification of the anterior longitudinal ligament (OALL).

Methods: We retrospectively reviewed cases performed at our institution between January 2015 and December 2018; adult (age ≥18 years) patients who underwent anterior cervical decompression and fusion in the presence of dysphagia and OALL. Ten patients (9 male, 1 female, mean age 64.4 years) with OALL who underwent ACDF were included. Charts were reviewed for demographics and comorbidities. Primary outcomes assessed were intra- and postoperative complications. Secondary outcomes were fusion rates, instrumentation failure, postsurgical instability/deformity, and readmission rates.

Results: The average duration of symptoms prior to surgery was 12.3 months. All patients presented with dysphagia (mean Bazaz score 2.0). The average number of levels with OALL was 4.7 (±1.67). All patients underwent ACDF and 3 patients underwent additional posterior cervical fusion for kyphotic deformity correction or when extensive laminectomy was required. We did not encounter any intraoperative complications. Eight patients (72%) had solid fusion demonstrated on the lateral x-rays and no evidence of progressive kyphotic deformity. We did not encounter any instrumentation failure or loosening. Two patients developed recurrence of dysphagia (Bazaz scores 2 and 3 respectively).

Conclusion: ACDF for OALL with dysphagia and concomitant myelopathy in our small series of 10 patients demonstrate good fusion and clinical outcomes. Larger studies will be necessary to determine the optimal treatment for patients with dysphagia due to OALL.

Keywords: ACDF; OALL; OPLL; anterior osteophytes; diffuse idiopathic skeletal hyperostosis (DISH); dysphagia.

FIgure 1

Patient 1: Computed tomography (CT) cervical spine, sagittal (left) and axial views. Ossification of the anterior longitudinal ligament (OALL) spanning from C2 to superior portion of C6, with a prominent osteophyte at C3/C4.

Figure 2

Patient 1: Barium swallow study showing impaired swallowing at level of C3-C4.

Figure 3

Patient 1: Lateral and anterior/posterior upright cervical X-ray after resection of OALL and C3/C4 ACDF. Preoperative computed tomography (CT; sagittal and axial views) of patient X with ossification of the anterior longitudinal ligament (OALL) (bottom).

Figure 4

Pre- and postoperative lateral cervical radiographs of patient 3 with ossification of the anterior longitudinal ligament (OALL) after resection of osteophytes and anterior cervical discectomy and fusion (ACDF) C4-C7 with posterior cervical decompression and fusion C2-T2.

Figure 5

Patient 5 underwent C5 – C6 ACDF with zero-profile spacer for ossification of the anterior longitudinal ligament (OALL) and myelopathy and continued to have persistent dysphagia postprocedure. Pre- and postoperative lateral cervical radiographs (left and right respectively).