{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T20:35:39Z","timestamp":1777494939504,"version":"3.51.4"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL. After posterior surgery, some patients require revision surgery because of late neurological deterioration due to kyphotic changes in cervical alignment or OPLL progression. Here, the authors retrospectively investigated the surgical results and complications of revision ACDF after initial posterior surgery for OPLL.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This was a single-center, retrospective study. Between 2006 and 2013, 19 consecutive patients with cervical OPLL who underwent revision ACDF at the authors' institution after initial posterior surgery were evaluated. The mean age at the time of revision ACDF was 66 \u00b1 7 years (\u00b1 SD; range 53\u201378 years). The mean interval between initial posterior surgery and revision ACDF was 63 \u00b1 53 months (range 3\u2013235 months).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The mean follow-up period after revision ACDF was 41 \u00b1 26 months (range 24\u2013108 months). Before revision ACDF, the mean maximum thickness of the ossified posterior longitudinal ligament was 7.2 \u00b1 1.5 mm (range 5\u201310 mm), and the mean C2\u20137 angle was 1.3\u00b0 \u00b1 14\u00b0 (range \u221240\u00b0 to 24\u00b0). The K-line was plus (OPLL did not exceed the K-line) in 8 patients and minus in 11 (OPLL exceeded the K-line). The mean Japanese Orthopaedic Association score improved from 10 \u00b1 3 (range 3\u201315) before revision ACDF to 11 \u00b1 4 (range 4\u201315) at the last follow-up, and the mean improvement rate was 18% \u00b1 18% (range 0%\u201360%). A total of 16 surgery-related complications developed in 12 patients (63%). The main complication was an intraoperative CSF leak in 8 patients (42%). Neurological function worsened in 5 patients (26%). The deterioration was due to spinal cord herniation through a defective dura mater in 1 patient, unidentified in 1 patient, and C-5 palsy that gradually recovered in 3 patients. Reintubation, delirium, and hoarseness were observed in 1 patient each (5%). No patient required reoperation for reconstruction failure, and all patients eventually had a solid bony fusion.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>ACDF as revision surgery after initial posterior surgery for cervical myelopathy due to OPLL is associated with a high incidence of intraoperative CSF leakage and an extremely low improvement rate. The authors think that while the use of revision ACDF must be limited, it is indispensable in special cases, such as progressing myelopathy following posterior surgery due to a very large beak-type OPLL that exceeds the K-line. Postoperative OPLL progression and\/or kyphotic changes can possibly cause later neurological deterioration. Fusion should be recommended at the initial surgery for many cases of cervical OPLL to prevent such a challenging revision surgery.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.9.spine16430","type":"journal-article","created":{"date-parts":[[2017,1,27]],"date-time":"2017-01-27T15:02:27Z","timestamp":1485529347000},"page":"466-473","source":"Crossref","is-referenced-by-count":54,"title":["Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament"],"prefix":"10.3171","volume":"26","author":[{"given":"Seiichi","family":"Odate","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jitsuhiko","family":"Shikata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsunemitsu","family":"Soeda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoru","family":"Yamamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinji","family":"Kawaguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-spine16430","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1097\/BSD.0b013e3181c7e91e","article-title":"Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine","volume":"24","author":"Chen Y,","year":"2011","unstructured":"Chen Y, Guo Y, Lu X, Chen D, Song D, Shi J, : Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine. 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