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REFERENCES
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 | Fig. 1.Diagnostic imagings of cervical OPLL. (A) Flexion / Extenion dynamic radiograms show no definite detetectable motion at the continous portion of OPLL. OPLL is frequently overlooked on plain radiograms because of superimposed bony structures such as facets and laminae. (B) Sagittal reconstruction CT scan shows a long strip of ossification posterior to the C2-C4 verte-bral bodies and mixed configuration at C5-7. (C) Axial CT shows ossified mass with a hole inside enchroaching spinal canal. (D) Three dimensional reconstruction CT scans show coronal and sagittal configuration of OPLL. (E) Sagittal T2-weighted MRI shows bandlike low or no signal intensity of ossified mass compressing spinal cord and small linear high-intensity area (fatty marrow) posterior to C6 and intramedullary bright signal posterior to C5-6. (F) Axial T-weighted MRI shows fuge ossified mass compressing spinal cord. |
 | Fig. 2.Classification of OPLL by Investigation Committee of Japan. (A) Segmental type (B) Continuous type (C) Mixed type (D) Other (localized) type |
 | Fig. 3.OPLL in Evolution. Axial T2-weighted MRI (A) and CT scan (B) show OEV-like mass compressing spinal cord. OEV mass, especially at C5-6, shows inhomogeneity of the mixed signals reflecting hypertrophied ligamentous and calcified or ossified contents. |
 | Fig. 4.A 54-year-old female with OPLL of cervical (A), Thoracic (B) and lumbar spine (C) and ossification of yellow ligament (OYL) of Thoracic spine (B). |
 | Fig. 5.Anterior decompressive surgery. (A) Sagittal T2-weighted MRI shows localized type of OPLL compressing spinal cord at C4-5. (B) Post-op. lateral radiogram shows partial corpectomy of C4,5 and iliac bone graft and plate fixation. (C) Hematoxylin-eosin staining of the OPLL specimen achieved from same patient showing osteoblast (black arrows) and osteocytes (black arrowheads) in ossified areas, chondrocytes (black hollow arrows) in cartilaginous areas, and fibroblasts (white hollow arrows) in unossified areas (×40). |
 | Fig. 6.A 67-year-old male with cervical OPLL complained of both hand clumsiness and walking difficulty. (A) Pre-op. T2-weighted MRI show marked cord compression with intramedullary high signal intensity at C4-5. (B) Post-op. T2-weighted MRI show expansion of spinal cord and recovery of subarachnoid space and still show intramedullary high signal intensity at the previ-ous maximum cord compression area. |
 | Fig. 7.Posterior migration of spinal cord is more effective in lordotic cervical curve (A), however, local dural expansion effect can be expected even in straight (B) and kyphotic cervical curve (C). |
Table 1.
Technical Points for Expansive Open Door Laminoplasty
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