Anterior cervical discectomy and fusion vs posterior laminoplasty for the treatment of myelopathy due to two-level localized ossification of the posterior longitudinal ligament

Abstract

We conducted a retrospective study to compare the clinical and radiological results of anterior cervical discectomy and fusion (ACDF) and posterior laminoplasty for two-level localized ossification of the posterior longitudinal ligament (OPLL). ACDF and posterior laminoplasty are performed for localized OPLL at the disc and vertebral body levels, respectively. Eighty six patients with two-level localized OPLL who underwent surgery from January 2011 to December 2016 were retrospectively investigated (41, ACDF group; 45, laminoplasty group). Clinical outcomes were reviewed, and radiologic results such as occupying ratio (OR), space available in the spinal cord, cranial and caudal OPLL-to-disc distance (ODD)/posterior body height (PBH) ratios, segmental angle, C2–C7 Cobb angle, T1 slope, C2–C7 sagittal vertical axis (SVA), and range of motion were investigated. Patients were followed-up for an average of 42.7 ± 10.5 months. Clinical outcomes, postoperative OR, and space available in the spinal cord were significantly improved at the final follow-up in both groups. Preoperatively, the OR and cranial and caudal ODD/PBH ratios were not significantly different between the groups. Compared to pre-operative values, differences in the segmental and C2–C7 Cobb angles at the final follow-up were statistically significant for the ACDF group ( P < .05). The mean operative time, bleeding volume, and the duration of hospitalization were significantly lower in the ACDF group than in the laminoplasty group ( P < .05). Complications occurred in 1 ACDF case and in 5 laminoplasty cases. Both ACDF and laminoplasty provided satisfactory clinical and radiologic outcomes for two-level localized OPLL. However, ACDF was associated with a lower operation time, bleeding loss, duration of hospitalization, and complications.

Modified ACDF Technique for the Treatment of Centrum Focal Ossification of the Posterior Longitudinal Ligament: A Case Report

“…These methods directly eliminate premyelopathy and decompress the spinal canal through an anterior cervical approach, and similar treatment experiences have been shared globally. 10 , 11 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 …”

Comparison of the outcome after anterior cervical ossified posterior longitudinal ligament en bloc resection versus posterior total laminectomy and fusion in patients with ossification of the cervical posterior longitudinal ligament: a prospective randomized controlled trial

“…The PTLF was performed as described using a Mountaineer lateral mass screw fixation system (Depuy Synthes Spine, USA). 8,18-20 In order to accomplish sufficient posterior shifting and total decompression of the spinal cord, the posterior constructs are usually twice as long as the anterior constructs. When undertaking anterior decompression in a patient with C4-5 OPLL, the vertebral bodies of C4 and C5 are resected, while when undertaking posterior decompression, the spinous process and bilateral laminae of C3-7 are removed.…”

“…In order to further study the indications for ACOE, the patients were divided into subgroups according to the COR and K-line, respectively. Visual analogue scale (VAS) scores were used to assess pain, and the neck disability index (NDI) 18 was used as the neck-specific outcome measure.…”

“…The COR was defined as the largest ratio of the thickness of the ossified mass over the anteroposterior diameter of the bony cervical spinal canal on axial CT scans. Cervical lordosis was evaluated by the Cobb angle between C2 and C7, 18 and cervical range of motion (ROM) was defined as the difference in the C2-7 Cobb angle between flexion and extension radiographs. The cervical sagittal vertical axis (SVA) was defined as the distance between a plumb line dropped from the centre of C2 and the posterosuperior aspect of C7.…”

A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion

“…7 Indications for ACDF include cervical degenerative disc disease (CDDD), cervical spinal stenosis, and partial ossification of the posterior longitudinal ligament (OPLL). [8][9][10] In recent years, cervical disc arthroplasty (CDA), endoscopic spine surgery (ESS), and other procedures have developed rapidly and have been used to treat cervical spine diseases. CDA preserves the operating segment's range of motion and reduces the occurrence of adjacent segment degeneration (ASD).…”