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

• Published in: Orthopaedic surgery Vol. 15; no. 5; pp. 1414 - 1422
• Main Authors: Xue, Jing‐lai, Xue, Huo‐huo, Cui, Wei‐liang, Xiao, Jing, Liao, Zhong
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.05.2023; John Wiley & Sons, Inc; Wiley
• Subjects: Anterior cervical discectomy and fusion; Back surgery; Bone density; Case Report; Case Reports; Cervical vertebra; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - pathology; Cervical Vertebrae - surgery; Diskectomy - adverse effects; General anesthesia; Humans; Hypertension; Ligaments; Longitudinal Ligaments - surgery; Magnetic resonance imaging; Muscle strength; Neck pain; Neck Pain - surgery; Ossification of posterior longitudinal ligament; Ossification of Posterior Longitudinal Ligament - pathology; Ossification of Posterior Longitudinal Ligament - surgery; Osteogenesis; Physiology; Retrospective Studies; Spinal cord; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; Spinal Cord Diseases - surgery; Spinal Fusion - methods; Spondylosis - complications; Spondylosis - surgery; Surgical techniques; Tendons; Treatment Outcome; Cervical vertebra; Anterior cervical discectomy and fusion; Ossification of posterior longitudinal ligament
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13711

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. Anterior cervical discectomy fusion (ACDF) is often used to treat cervical spondylosis with compression of the anterior part of the spinal cord, but is unable to treat posterior longitudinal ligament (OPLL) with long segments or special locations. We treated a man in June this year who had a specially positioned cervical vertebra OPLL. In the absence of traditional surgical options, we modified the ACDF technique: the intervertebral disc was removed after the anterior longitudinal ligament was exposed, and a small groove was removed above the C5 vertebral body by using an ultrasound osteotomy. After careful separation of the dura and bone mass, the lesion was removed and the cervical spine was fixed. At the last follow‐up, cervical curvature and spinal canal volume recovered. The VAS score of neck pain decreased from 7 points before operation to 1.5 points at last follow‐up. And the JOA score increased from 10 points before operation to 29 points at last follow‐up.