Utility of Posterior Longitudinal Ligament Resection During Anterior Cervical Decompression for Radiculopathy

Background: Anterior cervical diskectomy and fusion (ACDF) is the main surgical treatment of cervical radiculopathy. Controversy exists about the need to resect the posterior longitudinal ligament (PLL) to directly decompress the nerve roots, or if it is sufficient to indirectly decompress with diskectomy and graft placement. The objective of this study was to determine the effect of PLL resection after ACDF.

Methods: A retrospective review was performed of all patients that underwent first-time ACDF for cervical radiculopathy at a single tertiary care institution between 1999 and 2013. Comparative analyses and multivariable logistic regression were performed.

Results: Two hundred patients were included with a mean follow-up of 39 months. Average age was 54 years, 62% were women, and diabetes and current smoking status were noted in 11% and 15%, respectively. PLL resection was performed in 127 patients (64%), and no significant differences in baseline characteristics were observed between the 2 cohorts. One durotomy occurred in the resected PLL cohort, and none were seen in the unresected PLL group. No differences were seen in perioperative complications. At the time of last follow-up, improvement in radiculopathy was observed in 94% of the resected PLL group compared with 81% of the unresected PLL group (P = 0.008). After controlling for confounders, PLL resection had 3.8 times greater odds of leading to postoperative improvement in radiculopathy.

Conclusions: ACDF leads to a high rate of success in improvement of preoperative radiculopathy. Excision of PLL during surgery leads to 3.8 times greater odds of improvement in this symptom, with no significant difference in the complication rate.