ABSTRACT
Objective: To introduce a technical innovation for the treatment of severe multi-level thoracic ossification of posterior longitudinal ligament (OPLL). Methods: The detailed surgical procedure included isolation of vertebra-OPLL complex (VOC), implantation of screws and rods, and antedisplacement of the VOC. A patient diagnosed as multi-level thoracic OPLL with myelopathy was treated by this technique and the outcomes were reported. Results: Neurological outcomes achieved an evident improvement, with the recovery rate of modified-Japanese Orthopaedic Association score being 75%. The operation took 480 min and the intraoperative bleeding was 1 000 mL. Postoperative computed tomography and magnetic resonance imaging showed sufficient decompression of spinal cord. The occupation ratio of spinal canal improved from 86.6% to 58.8% in T2/3, and from 68.2% to 45.9% in T3/4. Conclusion: Posterior thoracic vertebra-OPLL complex antedisplacement and fixation is a feasible, theoretically safe and effective surgical option for the treatment of severe multi-level thoracic OPLL with myelopathy. The operation is simple and performed outside the spinal canal, and no ossified mass is removed. However, further studies with large-scale cases and control groups are required to reveal the applicability and safety of this technique.
ABSTRACT
Objective To report a novel technique named anterior controllable antedisplacement and fusion (ACAF) for the treatment of severe ossification of the posterior longitudinal ligament of the cervical spine, which allows for direct decompression of the nerve without resection of the ossification, making up for deficiencies in traditional anterior or posterior decompression. Methods The main surgical procedures of the ACAF included treatment of intervertebral space, removal of the anterior part of vertebrae, installation of titanium plate and interbody fusion cages, bilateral osteotomies of the vertebrae, and antedisplacement of the vertebrae ossification complex. The clinical data of two patients undergoing this surgery for severe ossification of the posterior longitudinal ligament of cervical spine were collected and analyzed. Results ACAF enabled direct decompression of spinal cord and nerve root through antedisplacement of the vertebrae ossification complex. The two patients who underwent ACAF gained satisfactory restoration with decompression of spinal cord and good recovery of neurological function, with no specific complications. Conclusion ACAF surgery takes into account the effectiveness of anterior direct decompression and the safety of posterior indirect decompression. Preliminary results shows that it can be used for severe cervical ossification of the posterior longitudinal ligament.