Concepts of Posterior Decompressive Surgery

Countries in East Asia have a high prevalence of myelopathyrelated to ossificationof the posterior longitudinal ligament(OPLL). Due to an ossified ligamentouscompression of the spinal cordfrom anterior, progressive cervical myelopathyresults in a high level of disability. In the 1960s, cervical laminectomythat completely removes laminae with attached ligamentousstructures was the only available surgical procedure for cervical myelopathy. Decompression was achieved with a posterior shift of the spinal cordby removing posterior elements of the cervical spine. However, the surgical outcomes were rather unpredictable due to various complications, such as iatrogenic spinal cordinjury and recurrent myelopathycaused by the epidural scar formation or development of postoperative kyphosis.