A Clinical Classification of Cervical Ossification of the Posterior Longitudinal Ligament to Guide Surgical Strategy

Study Design. A clinical classification of cervical ossification of the posterior longitudinal ligament (COPLL) was developed based on imaging findings. Objective. This study aimed to establish a clinical classification for COPLL and provide corresponding surgery strategies for each subtype. Summary of Background Data. A practical and reliable classification is needed to guide the treatment of COPLL. Methods. This study retrospectively reviewed plain radiographs, computed tomography scans, and magnetic resonance images of patients diagnosed with COPLL between 2018 and 2022 in Shanghai Changzheng Hospital. The types of COPLL were classified according to the location, morphology, and canal occupying ratio of the ossification mass. Interobserver and intraobserver reliability were evaluated using Cohen’s kappa. Results. A total of 1000 cases were included, which were classified into five types: Focal type (F type), Short-Sequential type (S type), Long-Sequential type (L type), High type (H type), and Mixed type (M type). In addition, each type could be classified into subtype 1 or subtype 2 according to the canal occupying ratio. Then each type could be further classified into other subtypes according to the location and morphology. The interobserver reliabilities in the first and second round were 0.853 and 0.887, respectively. The intraobserver reliability was 0.888. Conclusion. We classified COPLL into a system comprised of five types and several subtypes according to canal occupying ratio, location and morphology. Surgical strategies for each subtype are also suggested. This provides a theoretical guide for the description and surgical management of COPLL.