Hirabayashi et al. followed 53 patients treated surgically for cervical OPLL over 16 years. The study asks whether OPLL type predicts postoperative ossification behavior and should guide surgical approach selection.
Cervical OPLL management before this paper lacked a systematic framework linking morphologic type to surgical planning and postoperative behavior. This paper established that OPLL type — not the operation itself. Determines whether ossification will progress postoperatively.
When you see a patient with continuous or mixed OPLL, counsel them that progression after surgery is the rule (75%), not the exception. Choose posterior decompression for continuous and mixed types. Anterior decompression is technically hazardous in these cases and does not prevent progression. For mixed type requiring both anterior and posterior work, stage it: posterior first to create cord shifting room, then anterior 3–6 weeks later.
This paper also introduced the Hirabayashi open-door expansive laminoplasty. Now a foundational posterior cervical technique. And provided the first evidence-based rationale for why it may be preferred over laminectomy in OPLL.
Hirabayashi et al. followed 53 patients treated surgically for cervical OPLL over 16 years. The study asks whether OPLL type predicts postoperative ossification behavior and should guide surgical approach selection.
Cervical OPLL management before this paper lacked a systematic framework linking morphologic type to surgical planning and postoperative behavior. This paper established that OPLL type — not the operation itself. Determines whether ossification will progress postoperatively.
When you see a patient with continuous or mixed OPLL, counsel them that progression after surgery is the rule (75%), not the exception. Choose posterior decompression for continuous and mixed types. Anterior decompression is technically hazardous in these cases and does not prevent progression. For mixed type requiring both anterior and posterior work, stage it: posterior first to create cord shifting room, then anterior 3–6 weeks later.
This paper also introduced the Hirabayashi open-door expansive laminoplasty. Now a foundational posterior cervical technique. And provided the first evidence-based rationale for why it may be preferred over laminectomy in OPLL.