| Objective: Ossification of the cervical posterior longitudinal ligament (OPLL) has been prevalence in those people whose ages range from 50 to 60, and the disease's incidence ranges from 0.2 to 4% in the population with cervical spine disorders. Because of this disease in Japan in the high population, it also called the "Japan disease." OPLL is characterized by replacement of the ligamentous tissue by ectopic new bone formation and has been recognized as one of the important causes of cervical myelopathy. Patients can be associated with mild to serious neurological complications due to spinal cord or nerve root compression or may be asymptomatic. There is consensus that surgical intervention is usually indicated in these cases who indicated serious complications, but which modus operandi will be the safest and the most effective one is still in sustainable dispute. In addition, there is also dispute about the influence of increased signal intensity of the spinal cord on T2-weighted MRI to the prognosis. The purpose of this study was to observe the results and complications of ossification of posterior longitudinal ligament of cervical spine with different surgical approaches, and to discuss the choice of operation methods, the influence of increased signal intensity of the spinal cord on T2-weighted MRI to the prognosis, and the prevention of the complications.Methods: Retrospectively analyze 132 patients with OPLL of cervical spine by surgical treatments that have complete follow-up data from January 2001 to October 2008 in the Third Hospital of Hebei Medical University. Among the patients, 90 were male and 42 were female, with mean age 54.6±10.7 (range from 32 to 77). Forty-six of them were decompressed from an anterior approach, 59 from a posterior approach and 27 from a posterior-anterior approach. According to the Japanese Orthopaedic Association (JOA score standard), All patients neural function was recorded according to JOA score, and the surgeical complications were recorded, neural improvement rates (rate of the improved JOA score, RIS) were calculated simultaneously. RIS= (postoperative score-Preoperative score) / (17-Preoperative score)×100%. The curative effect was divided into four classes according to the RIS, excellent: The RIS is above 75%, good: The RIS is 74%~50%, general: The RIS is 49%~25%, bad: The RIS is below 25%. Record the JOA scores of preoperative, one week after operation and the end of the follow-up. Calculate the improvement rate after operation and record the surgical complications. Analyze the outcomes of the three different operations. According to whether increased signal intensity of the spinal cord on T2-weighted MRI can be divided into two groups. Compare the postoperative improvement rate and analyze the influence of increased signal intensity of the spinal cord on T2-weighted MRI to the prognosis.Result: The mean JOA score before operation was (9.67±2.08) and the score after operation was (15.04±1.09) in the anterior operation group; The mean JOA score before operation was (9.49±1.88) and the score after operation was (14.66±1.11) in the posterior operation group; The mean JOA score before operation was (9.04±1.89) and the score after operation was (15.00±1.14) in the posterior-anterior combined operation group. Three groups postoperative JOA score improved significantly and the differences were significant. The mean postoperative improvement rate was (74.95±9.83)% in patients treated by anterior decompression, (69.90±9.56)% in those treated by posterior decompression and (76.61±10.19)% in those by posterior-anterior approach surgical treatment. The postoperative improvement rate of anterior surgery and posterior-anterior combined surgery were superior to the posterior surgery and the differences were statistically significant. The mean postoperative improvement rate was (67.04±7.91)% in ISI group and (77.88±9.11)% in no ISI group and the difference was statistically significant. There were 3 patients with cerebrospinal fluid leakage; 1 case had incomplete paralysis; 1 case had injury to recurrent laryngeal nerve; 1 case had internal fixation loosening; 9 cases had axial symptoms; 4 cases had C5 nerve root palsy; 1 case had hematoma and 1 case had fat liquefaction after operation.Conclusion: 1. According to the specific condition of patients to choose the appropriate surgical procedures, three can get good effect. 2. The postoperative improvement rate of anterior approach and posterior-anterior approach were superior to posterior approach. 3. The postoperative improvement rate of ISI group was superior to no ISI group. The spinal cord signals change has certain value to judge the prognosis. 4. Sufficient preoperative preparation, careful operation and better nursing are the important measures to reduce the complications and enhance the curative effect.
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