Review of Vertebral Body Sliding Osteotomy for Cervical Myelopathy with Rigid Kyphosis

An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review

Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.

Genetic Odyssey to Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Systematic Review

Despite numerous studies, the pathogenesis of ossification of the posterior longitudinal ligament (OPLL) is still unclear. Previous genetic studies proposed variations in genes related to bone and collagen as a cause of OPLL. It is unclear whether the upregulations of those genes are the cause of OPLL or an intermediate result of endochondral ossification process. Causal variations may be in the inflammation-related genes supported by clinical and updated genomic studies. OPLL demonstrates features of genetic diseases but can also be induced by mechanical stress by itself. OPLL may be a combination of various diseases that share ossification as a common pathway and can be divided into genetic and idiopathic. The phenotype of OPLL can be divided into continuous (including mixed) and segmental (including localized) based on the histopathology, prognosis, and appearance. Continuous OPLL shows substantial overexpression of osteoblast-specific genes, frequent upper cervical involvement, common progression, and need for surgery, whereas segmental OPLL shows moderate-to-high expression of these genes and is often clinically silent. Genetic OPLL seems to share clinical features with the continuous type, while idiopathic OPLL shares features with the segmental type. Further genomic studies are needed to elucidate the relationship between genetic OPLL and phenotype of OPLL.