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Drilling technique may keep spinal cord safe during corpectomy for OPLL

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ORLANDO, Fla. — By following some key principles, a surgeon reported avoiding spinal cord injuries in 138 patients who underwent a cervical corpectomy for ossification of the posterior longitudinal ligament.

At Spine Summit 2016: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting in a session on how avoid disaster in spine surgery, Vedantam Rajshekhar, MD, said the principles he uses may be helpful to use in the surgery of patients who are kyphotic. These principles include understanding the morphology of the ossification of the posterior longitudinal ligament (OPLL) prior to surgery and carefully thinning out the thick part of the ligament by drilling it prior to detachment.

Vedantam Rajshekhar

“In spite of all these efforts, you do tend to have a higher risk of [cerebrospinal fluid] CSF leak in corpectomies for OPLL,” Rajshekhar, of Vellore, India, said.

In one of his corpectomy series, Rajshekhar said a CSF leak occurred in about 6% of patients. However, he noted the leaks resolved with a special repair technique and 5 days of bedrest.

Rajshekhar typically goes in from the front to decompress the cord and usually does an uninstrumented corpectomy. He often performs one that is multilevel.

“One of the things you need to do before you go in for surgery is pay close attention to the imaging, both the MRI and the CT scan, to study the morphology of the ossified posterior longitudinal ligament,” Rajshekhar said.

During surgery, look for signs of dural involvement and ossification, he said.

Because he starts drilling the OPLL at the thickest part with a Rosen burr, Rajshekhar said, “One needs to pay attention to the symmetry or asymmetry of the OPLL.”

Also, he noted, the OPLL should not be detached until it is uniformly thin. — by Susan M. Rapp

For more information:

Rajshekhar V. Cervical corpectomy for OPLL: Avoiding spinal cord injury. Presented at: Spine Summit 2016: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting; March 16-19, 2016; Orlando, Fla.

Disclosure: Rajshekhar reports no relevant financial disclosures.