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

Abstract

Background Anterior cervical discectomy fusion (ACDF) is a surgical procedure used to treat cervical spondylosis with anterior spinal cord compression. However, there are limitations to traditional ACDF and posterior indirect decompression when the anterior source lesion is in the center of the cervical vertebra. Case Presentation On June 8, 2022, our department treated a patient with cervical spondylotic myelopathy—whose high posterior longitudinal ligament (OPLL) occupied the central position of the vertebral body—with modified ACDF. The preoperative surgical plan was designed based on the relevant imaging data and assay index. Also, the visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scores, and imaging parameters of neck pain were recorded and compared. Postoperative imaging data showed that cervical curvature was recovered and spinal canal compression was relieved. The VAS score for neck pain decreased from 7 preoperatively to 1.5 at the last follow‐up, while the JOA score increased from 10 preoperatively to 29 at the last follow‐up. The volume of the spinal canal was restored. Simultaneously, the patient's extremity muscle strength improved and muscle tension decreased. Conclusions Modified ACDF may be an effective surgical method for resolving spinal cord compression in a specific location when bone mineral density is good. We can effectively avoid iatrogenic nerve injury and symptom recurrence by removing the vertebral body and the lesion directly.

Static mechanical analysis of the vertebral body after modified anterior cervical discectomy and fusion (partial vertebral osteotomy): a finite element model

“…In a previous clinical study [ 12 ], we proposed a novel technique that was based on the modification of ACDF, i.e., partial osteotomy of the vertebral body via the anterior approach and direct access to the posterior edge of the vertebral body to remove the ossified compression. In a preconceived scenario, this technique would not be limited by a narrow field of view or cause excessive bone damage and would obtain a superior range of motion in the cervical spine by fixing fewer segments.…”

“…Therefore, the case of ossification at the posterior edge of the central vertebral body with little distraction stimulation is extremely rare, and the surgical treatment criteria required by the guidelines do not apply. Previously, we reported a case of focal ossification at the posterior margin of the vertebral body [ 12 ], in which a modified ACDF (Mod ACDF) technique was used to partially osteotomize the diseased vertebra and remove it along with the ossified mass.…”