Anterior controllable antidisplacement and fusion surgery for the treatment of multilevel severe ossification of the posterior longitudinal ligament with myelopathy: preliminary clinical results of a novel technique

Sun, Jingchuan; Sun, Jingchuan; Xu, Ximing; Yang, Yong; Wang, Yuan; Kong, Qingjie; Yang, Haisong; Guo, Yongfei; Han, Dan; Jiang, Jingjing; Shi, Guodong; Wen, Yan; Jia, Lianshun

doi:10.1007/s00586-017-5437-4

Cited by 55 publications

(56 citation statements)

References 29 publications

(28 reference statements)

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“…The K-line connects the midpoints of the spinal canal at C2 and C7 on neutral lateral radiographs. When anterior compression of the OPLL exceeds this line, the K-line is defined as negative [ 16 ]. Cervical lordosis was measured as the angle between a line parallel to the posterior aspect of the C2 vertebral body and that of the C7 body.…”

Section: Methodsmentioning

confidence: 99%

“…Sun et al first described the anterior controllable antidisplacement and fusion (ACAF) technique for the treatment of multilevel severe ossification of the posterior longitudinal ligament with myelopathy [ 16 ]. The goal of ACAF is to isolate and “actively transport” residual osteophytes or ossification to restore the space of the spinal canal and thus achieve direct decompression of the neural elements with their location unchanged.…”

Section: Introductionmentioning

confidence: 99%

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A novel revision surgery for treatment of cervical ossification of the posterior longitudinal ligament after initial posterior surgery: preliminary clinical investigation of anterior controllable antidisplacement and fusion

Zhang

Xing

et al. 2018

J Orthop Surg Res

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BackgroundCervical ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. Posterior decompression surgery is reported to be an effective and comparatively safe procedure with few complications for treatment of patients with myelopathy caused by OPLL. However, some patients require revision surgery because of late neurological deterioration due to OPLL progression or kyphotic changes in cervical alignment. This study reports preliminary clinical results of anterior controllable antidisplacement and fusion (ACAF), a novel revision surgery after initial posterior surgery for OPLL.MethodsFrom January 2017 to June 2018, ten patients with cervical OPLL who underwent ACAF revision surgery after initial posterior surgery were included in this study. The mean age was 62.1 ± 8.0 years (52–78), and the mean interval between initial posterior surgery and revision was 78.0 ± 48.2 months (5–180). The Japanese Orthopaedic Association (JOA) scales, Neck Disability Index (NDI), visual analog scale (VAS), and surgical complications were recorded.ResultsThe mean surgery time was 179.3 ± 41.8 min (120–240), and the mean blood loss was 432.5 ± 198.3 ml (225–850). The patients were followed up for at least 12 months. The JOA scores improved from 8.7 ± 2.8 to 13.4 ± 2.4; the mean improvement rate was 59.9% ± 16.1%. Postoperative NDI and VAS scores were 13.3 ± 3.7 and 2.0 ± 1.6, respectively, and were significantly improved compared to those before the procedure (P < 0.05). Cervical lordosis improved from 3.8 ± 4.3° to 17 ± 4.6° after revision surgery. There was only one instance of cerebrospinal fluid (CSF) leakage; no instances of postoperative hematoma, C5 root palsy, or hoarseness occurred.ConclusionsThe present study demonstrates that excellent postoperative outcomes can be achieved with the ACAF technique for revision treatment of OPLL. Though further study is required to confirm the conclusion, this novel technique has the potential to serve as an alternative surgical technique for revision treatment of OPLL.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A novel revision surgery for treatment of cervical ossification of the posterior longitudinal ligament after initial posterior surgery: preliminary clinical investigation of anterior controllable antidisplacement and fusion

Zhang

Xing

et al. 2018

J Orthop Surg Res

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“…Cervical spondylosis myelopathy (CSM) is a neurological disorder caused by the narrowing of the cervical spinal canal as a result of degenerative changes in the cervical spine with the advancing age in the population. [1][2][3] Various pathologic processes in the cervical spine may cause mechanical compression of the spinal cord and yield to degenerative cervical myelopathy, and the ossification of the posterior longitudinal ligament (OPLL) has been recognized as one of the most common causes of severe cervical myelopathy. [4,5] Since OPLL is a multifactorial disease and the clinical symptoms are severe and progressive, conservative treatment is not effective and surgical intervention is indicated.…”

Section: Introductionmentioning

confidence: 99%

“…[4,5] Since OPLL is a multifactorial disease and the clinical symptoms are severe and progressive, conservative treatment is not effective and surgical intervention is indicated. [1,[6][7][8] Surgical strategies for cervical myelopathy due to OPLL can be divided into anterior and posterior approach, and the performed procedures decision was based on the pathologic features of the CSM. [2,7,8] Although anterior and posterior approach has its advantages and limitations, surgery share the same goal of decompression the spinal cord and relieving neurological compression form restore spinal canal space for spinal cord.…”

Section: Introductionmentioning

confidence: 99%

“…[16][17][18] The complication of C5 palsy, which been considered main in the posterior surgery, have been found still in the anterior surgery of CSM, especially in OPLL. [19,13,1,9,20,21] The C5 palsy in OPLL patients was the cervical spinal cord injuries, which different from other spinal cord injuries because of ossification induced narrowing of the spinal canal and limitation of intervertebral mobility. [21,22,18,20] There are many factors that affect the C5 palsy in surgical treatment of OPLL, but the spinal canal stenosis and the spinal compression degrees may be an important factor in affection on it.…”

Section: Introductionmentioning

confidence: 99%

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C5 palsy in the treatment of cervical spondylosis myelopathy with ossification of the posterior longitudinal ligament

Yan¹,

Zhang²,

Zhang³

2020

Preprint

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Background There are many factors that affect the C5 palsy in the treatment of cervical spondylosis myelopathy (CSM) with ossification of the posterior longitudinal ligament (OPLL), but the spinal compression degrees may be an important factor in affection on it. Objective The purpose of this study was to evaluate the effect of spinal cord compression degrees on the clinical outcomes of OPLL patients which been treated by anterior and posterior surgery. Methods From May 2010 to October 2017, 145 patients cervical spondylosis myelopathy with OPLL (spinal canal narrowing by the OPLL exceeded 30%) were enrolled in this study; 76 patients received anterior cervical corpectomy and fusion surgery (ACCF), and 69 patients had posterior cervical decompression and laminoplasty procedures (PCDL). The clinical outcomes of pain relief (visual analog scale, VAS), functional disability (neck disability index, NDI) were recorded at baseline and at the final follow-up. Results There were five patients with C5 palsy in this series cases (two in ACCF and three in PCDL), and the rate is 4.1% (3.2% in ACCF and 5.2% in PCDL, P > 0.05). Five C5 palsy cases had more than 50% compressed degrees of dural sac and flattened spinal cord, and the compressed dural sac and flattened spinal cord had totally expansion after operation. There were no patients resented with CSF leakage in PCDL group, and six patients presented with CSF leakage in ACCF. The mean postoperative canal diameter were significant better than preoperative in PDL patients (P < 0.01). The average spinal sagittal and axial compressive ratio were significantly decreased from preoperative in ACR and PDL groups (P < 0.01). The mean cervical ROM values were decreased in ACR and PDL groups (P< 0.05). Conclusions Based on the results of this study, anterior and posterior surgery was effective and safe in the treatment of the OPLL patients. The complication of C5 palsy were no related in the surgery methods, but may be related the degrees of spinal cord compressed.

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Anterior controllable antedisplacement fusion as a choice for 28 patients of cervical ossification of the posterior longitudinal ligament with dura ossification: the risk of cerebrospinal fluid leakage compared with anterior cervical corpectomy and fusion

et al. 2018

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Purpose To compare the incidence rate of cerebrospinal fluid (CSF) leakage between anterior controllable antedisplacement fusion (ACAF) and anterior cervical corpectomy and fusion (ACCF) in the treatment of ossification of the posterior longitudinal ligament (OPLL) with dura ossification (DO). Methods In the period from June 2015 to June 2017, ACAF and ACCF were performed on patients with OPLL with DO. Double-layer sign was observed on axial bone window of CT images. The operation duration, blood loss, and hospital stay were measured. Radiologic assessment included occupying rate, type and extent of OPLL, decompression width, postoperative area of the spinal canal, and anteroposterior diameter of the spinal cord. The JOA scoring system was used to evaluate the neurological status. Surgery-related complications such as CSF leakage and spinal cord or nerve injury were all recorded. Results There were 28 patients in ACAF group and 31 in ACCF group. On cross-sectional CT, decompression width and postoperative spinal canal area were both significantly larger in the ACAF group than that in the ACCF group (P < 0.01). The anteroposterior diameter of the spinal cord was significantly larger in the ACAF group (P < 0.05). Mean JOA score was better in the ACAF group (P < 0.05). In the ACCF group, seven (22.6%) patients had CSF leakage. However, only one (3.6%) presented with CSF leakage in the ACAF group. The difference of incidence rate of CSF leakage was significant (P < 0.01). Conclusions ACAF, which can significantly reduce CSF leakage and achieve good neurological recovery, is a good option to treat cervical OPLL with DO.Haisong Yang and Jingchuan Sun contributed equally to this paper.

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Anterior controllable antidisplacement and fusion surgery for the treatment of multilevel severe ossification of the posterior longitudinal ligament with myelopathy: preliminary clinical results of a novel technique

Cited by 55 publications

References 29 publications

A novel revision surgery for treatment of cervical ossification of the posterior longitudinal ligament after initial posterior surgery: preliminary clinical investigation of anterior controllable antidisplacement and fusion

A novel revision surgery for treatment of cervical ossification of the posterior longitudinal ligament after initial posterior surgery: preliminary clinical investigation of anterior controllable antidisplacement and fusion

C5 palsy in the treatment of cervical spondylosis myelopathy with ossification of the posterior longitudinal ligament

Anterior controllable antedisplacement fusion as a choice for 28 patients of cervical ossification of the posterior longitudinal ligament with dura ossification: the risk of cerebrospinal fluid leakage compared with anterior cervical corpectomy and fusion

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