Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy

Sun, Kaiqiang; Wang, Shunmin; Huan, Le; Sun, Jingchuan; Xu, Ximing; Sun, Xiaofei; Sun, Jingchuan; Guo, Yongfei

doi:10.1007/s00586-019-06216-6

Cited by 15 publications

(15 citation statements)

References 31 publications

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“…ACAF combines the advantages of direct decompression as occurs with ACCF with the limited manipulation of the canal contents as occurs with the posterior approach 4-6 . The procedure considers the ossified mass and the vertebral body as a single unit.…”

Section: Rationalementioning

confidence: 99%

“…Expected Outcomes: This procedure can yield satisfactory clinical outcomes with fewer surgery-related complications 1,[4][5][6]9 . A single-center, prospective, randomized controlled study showed significantly better Japanese Orthopaedic Association scores and recovery rates at 1 year for ACAF compared with laminoplasty for the treatment of multilevel OPLL in cases in which the occupying ratio of the canal was .60% occluded or the K-line (i.e., a virtual line between the midpoints of the anteroposterior canal diameter at C2 and C7) was negative 9 .…”

mentioning

confidence: 99%

“…Without direct instrument manipulation inside the canal, the occurrence of cerebrospinal fluid leakage, hemorrhage, and intraoperative neural injury can be minimized 5 . Compared with a posterior approach, ACAF can achieve more decompression of the cord, especially in patients with cervical kyphosis and those with >60% of the spinal canal occluded 6 .…”

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confidence: 99%

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Anterior Cervical Controllable Antedisplacement and Fusion (ACAF)

Sun

Chen

et al. 2022

JBJS Essential Surgical Techniques

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Background:Anterior cervical controllable antedisplacement and fusion (ACAF) is utilized for the treatment of symptomatic ossification of the posterior longitudinal ligament (OPLL). The aims of the procedure are to directly relieve ventral compression of the spinal cord, to reconstruct the spinal canal and restore cervical alignment, and to achieve satisfactory clinical recovery.Description:The detailed steps to perform ACAF have been described previously1. Briefly, following induction of general endotracheal anesthesia, a standard right- or left-sided Smith-Robinson incision is made. Discectomies are performed at the involved levels. By measuring the thickness of the OPLL on an axial preoperative computed tomography scan at each compressed level, the amount of each anterior vertebral body to be resected can be calculated preoperatively. This was, in general, equal to the thickness of the ossified mass at the same level. The previously calculated portion of each involved body in the vertebral body-OPLL complex is resected. Following the creation of a contralateral longitudinal osseous trough, the prebent anterior cervical plate is then placed, and the screws are installed after proper drilling and taping on the remaining vertebral bodies. The screws utilized in this procedure should not be too short to achieve adequate purchase in the vertebral body. Subsequently, the intervertebral cages are inserted. Thus, the vertebral body-OPLL complex is temporarily stabilized for the next procedure. Next, an ipsilateral longitudinal osseous trough is created to completely isolate the vertebral body-OPLL complex. Notably, the objective of complete isolation of the vertebral body-OPLL complex is to further anteriorly hoist the complex to decompress the spinal cord. Finally, screws are inserted through the plate and into each vertebral body and are gradually tightened to displace the bodies anteriorly. Allogenic iliac bone graft is placed in the longitudinal bone troughs to promote fusion.Alternatives:Nonoperative treatment is frequently ineffective. Traditional surgical interventions have included anterior cervical corpectomy and fusion (ACCF), posterior laminoplasty, and laminectomy2,3. ACCF focuses on resecting the ventral ossified mass in order to obtain direct decompression; however, this technique is very technically demanding, with a high risk of complications. In addition, the clinical benefits of ACCF will be limited when the OPLL extends over >3 levels. Posterior decompression can achieve indirect decompression by allowing the spinal cord to float away from the ossified mass. This technique depends largely on the preoperative presence of cervical lordosis and is contraindicated in patients with kyphosis or severe OPLL. In addition, posterior decompression surgery has been associated with a high incidence of late neurological deterioration and even revision surgery2.Rationale:ACAF combines the advantages of direct decompression as occurs with ACCF with the limited manipulation of the canal contents as occurs with the p...

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Section: Rationalementioning

confidence: 99%

mentioning

confidence: 99%

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Anterior Cervical Controllable Antedisplacement and Fusion (ACAF)

Sun

Chen

et al. 2022

JBJS Essential Surgical Techniques

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“…The difference between the maximum exion and extension was considered to re ect the angle. (4) local spinal cord angle: de ned as the angle formed by two lines tangential to the bilateral rims of the compressed spinal cord area at the maximal compression level on sagittal view of T2-weighted MRI [15]. Statistical analysis of the parameters was performed using the t test with the IBM SPSS software package, version 26.0 (IBM Corp., Armonk, USA).…”

Section: Radiological Assessmentmentioning

confidence: 99%

One-stage posterior laminectomy with instrumented fusion and foraminotomy for cervical ossification of posterior longitudinal ligament with radiculopathy pain

Shen

Luo

et al. 2021

Preprint

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ObjectiveTo explore the clinical efficacy of posterior LFF for cervical OPLL with radicular pain of upper limbs.MethodsBetween January 2014 and January 2018, 48 OPLL patients with radicular pain symptoms of upper limbs who underwent a one-stage posterior laminectomy and instrumented fusion with/without foraminotomy were reviewed retrospectively and divided into two groups: LF Group (laminectomy with instrumented fusion without foraminotomy) and LFF Group (laminectomy with instrumented fusion and foraminotomy). ໿Clinical data were assessed and compared between the two groups. The radicular pain of upper limbs and neck was measured using the visual analog scale (VAS). The neurological function was evaluated with the American Spinal Injury Association (ASIA) scale. Achievement of fusion and changes of sagittal alignment were investigated by postoperative plain x-ray or computed tomography (CT). Moreover, the decompression of spinal cord was evaluated based on postoperative MRI.ResultsAll the 48 patients were followed up for 24-42months with an average follow-up time of 31.1 ± 5.3 months. A total of 56 cervical intervertebral foramens were enlarged in 48 patients, including 40 case (83.3%) with 1 intervertebral foramens enlargement and 8 cases (16.7%) with 2 intervertebral foramen enlargements. There were no significant differences in intraoperative blood loss, ໿postoperative drainage amount, Japanese Orthopaedic Association (JOA) scores, JOA recovery rates, VAS scores for neck pain and ASIA grade between two groups. The mean operative time was shorter in the LF group compared with the LFF group. The ໿VAS score for arm pain was significantly lower while the surgical duration was longer in group B. No statistical difference was observed between the two group in terms of C2–C7 SVA, cervical lordosis, ໿focal angulation at the foraminotomy segment and local spinal cord angle. Compared with the LF group, there was no segmental kyphosis or instability where the additional posterior foraminotomy was performed in the LFF group.ConclusionsOne-stage posterior LFF can achieve satisfied clinical efficacy in improving neurological function and relieving the radicular pain of the upper limbs for OPLL patients with radiculopathy symptoms.

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“…Ossi cation of the posterior longitudinal ligament (OPLL) is one of the etiologies that result in myelopathy, and surgical intervention is indicated for patients with neurological de ciencies [1]. Various surgical techniques have been historically applied to treat OPLL, and each technique has individual indications, advantages, and disadvantages [2,3]. Anterior decompression and fusion for OPLL is technically demanding due to the potential risk of complications such as cerebrospinal uid leakage and neurological deterioration, especially for patients with multilevel OPLL accompanied by high spinal canal occupying ratio.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes Comparison of C2 Dome-like Expansive Laminoplasty Versus C2 Open-door Laminoplasty for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament Involving C2

Zhou

Xia

Chen

et al. 2020

Preprint

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Background: Cervical laminoplasty is a well-established surgical treatment for patients with cervical myelopathy due to OPLL. However, for cases with OPLL involving C2 segment, some surgeon preferred C2EL technique, but destruction of muscles attaching at C2 spinous process and lamina is inevitable. While C2DEL technique was also available which cause less destruction to the structures associated with C2. Nevertheless, it is still not confirmed whether it can achieve similar outcomes as C2EL. This study aimed to compare the clinical and radiographic outcomes of C2 dome-like expansive laminoplasty technique(C2DEL) and C2 extended laminoplasty technique(C2EL) applied in the treatment of cervical ossification of posterior longitudinal ligament (OPLL)involving C2 segment.Methods: Data of 56 patients with OPLL involving C2 segment who underwent cervical laminoplasty were retrospectively reviewed. 26 patients received C2EL technique while C2DEL technique was applied in another 30 patients. Functional outcomes evaluated by visual analog scale score for neck pain (VASSNP), Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score and Health-Related Quality-of-Life Short Form-36 Physical Component Summary (SF-36 PCS) were recorded and compared pre- and postoperatively. The radiographic outcomes assessed by the Cobb angle and range of motion (ROM) of cervical spine at C2-C7, as well as decompression effect at C2 level evaluated by space available for spinal cord (SAC) were measured in two groups. The intraoperative parameters including total blood loss and operation time were documented and compared between 2 groups.Results: At the final follow-up, JOA scores, NDI, and SF-36 PCS were significantly improved in both groups(all P＜0.05), but no significant differences were identified between two groups. VASSNP was reduced significantly in both groups(P＜0.05), but the cases in C2EL group experienced more severe neck pain than that of C2EL group(P＜0.05). Cobb angle at C2 and C7 and the cervical ROM in both groups reduced greatly, the SAC at C2 improved postoperatively and no significant difference was identified intergroup. No serious complications related to the surgical approach and instrumentation were observed in either group.Conclusion: C2DEL was comparable to C2EL for treating OPLL involving C2 segment. C2DEL was an ideal alternative treatment strategy for OPLL involving the C2 segment.

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Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy

Cited by 15 publications

References 31 publications

Anterior Cervical Controllable Antedisplacement and Fusion (ACAF)

Anterior Cervical Controllable Antedisplacement and Fusion (ACAF)

One-stage posterior laminectomy with instrumented fusion and foraminotomy for cervical ossification of posterior longitudinal ligament with radiculopathy pain

Clinical Outcomes Comparison of C2 Dome-like Expansive Laminoplasty Versus C2 Open-door Laminoplasty for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament Involving C2

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