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

Abstract

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.

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications

“…This technique allows for multilevel decompression to be achieved from an anterior approach without direct manipulation of the OPLL mass [41,42]. In comparison with a traditional ACCF approach, the ACAF technique demonstrated greater radiographic decompression, as well as significantly greater postoperative JOA scores and lower complication rates [41,43]. Another technique is the “skip” corpectomy and fusion (SCF) which aims to provide multilevel decompression while maintaining adequate stabilization [42].…”

“…To further minimize the risk of complications with ADF, Yoshii et al [63] have proposed use of intraoperative CT along with the ADF procedure. In a small RCT of 25 patients undergoing ADF using intraoperative CT, the enhanced imaging modality was found to confer better postoperative outcome and a lower rate of complications compared to ADF without intraoperative CT. More recently, the ACAF technique was used to treat to a small cohort of 28 patients with OPLL and evidence of DO, and successfully demonstrated a significantly lower rate of CSF leak with ACAF (3.6%) compared to anterior corpectomy (22.6%, p<0.01) [43].…”

Anterior Cervical Controllable Antedisplacement and Fusion (ACAF)

“…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.…”

Risk Factors and Predictive Models for Early Cerebrospinal Fluid Leak after Anterior Surgery for Degenerative Cervical Myelopathy

“…According to the literature, OPLL has been recognized as a risk factor for the occurrence of CSF leak in spinal surgery. Cervical OPLL usually presents with dura ossi cation (DO), and it is a great technical challenge to separate the ligament from the posterior longitudinal ligament once the ossi ed dura mater is fused with the posterior longitudinal ligament 25 . Hannallah et al 20 reported that the incidence of CSF leak in patients with OPLL after cervical spine surgery was 12.5%, which was 13.7 times higher than that in the group without OPLL, and the data in our survey turned out to be 4.45.…”