Resection of the posterior longitudinal ligament in anterior cervical decompression surgery: a retrospective study of the clinical and radiographic outcomes in Thailand.

Abstract

Study design: Retrospective study.

Purpose: To compare clinical and radiographic outcomes of patients undergoing anterior cervical decompression surgery with and without resecting the posterior longitudinal ligament (PLL).

Overview of literature: Resection of the PLL during anterior cervical decompression surgery is still a controversial topic among spine surgeons.

Methods: All patients undergoing anterior cervical decompression surgery from October 2018 to December 2023 were included in this cohort. The PLL was preserved in patients with cervical spondylosis with only axial neck pain, cervical spine injuries with an intact PLL and intervertebral disc, PLL ossification with double layer signs on magnetic resonance imaging studies, and cervical spine metastasis. Clinical outcomes were used to evaluate the visual analog scale for neck pain and a modified Japanese Orthopedic Association score. Radiographs were used to evaluate the device-level Cobb angle (CA), segmental CA, global CA, and sagittal vertical axis, and they were compared with postoperative measurements at 1 year.

Results: A total of 102 patients underwent surgical intervention. In 36 patients, PLL was preserved. The retractor time was shorter in the non-PLL resection group and was statistically significant (p=0.046). The non-PLL resection group had fewer complications, but this was not statistically significant (p=0.787). Both clinical and radiographic outcomes were improved after surgery, and there were no statistically significant outcome differences between the resection and non-resection groups.

Conclusions: Resecting the PLL in patients undergoing anterior cervical spine surgery may prolong retractor time and could potentially result in postoperative complications. However, it does not significantly affect radiographic outcomes regarding cervical spine alignment compared to patients where the PLL was not cut.