Abstract
BackgroundSevere localised ossification of the posterior longitudinal ligament (OPLL) should be directly removed by anterior approach, but the exposure during anterior cervical diskectomy and fusion (ACDF) is restricted and may increase the risk of a cerebrospinal fluid (CSF) leak. Corpectomy is facilitated to extirpate the ossification, but it is relatively more invasive. The purpose of this study was to investigate the feasibility and clinical outcome of enlarged ACDF in treating severe localised OPLL.MethodsTwenty-four selective patients with severe localised OPLL who underwent enlarged ACDF from January 2011 to July 2013 were retrospectively investigated. The Japanese Orthopaedic Association (JOA) scales, visual analogue scale (VAS), occupying rate (OR), fused segment height (FSH), sagittal segmental alignment (SSA), range of motion (ROM), and complications were investigated.ResultsAfter a mean 34.9-month follow-up, the mean JOA score increased from 9.5 ± 1.4 preoperatively to 14.1 ± 1.5 at the final follow-up (p < 0.05), while OR decreased from 58.9 ± 6.1 % pre- to 10.6 ± 5.5 % postoperatively (p < 0.05). The average VAS was 6.1 ± 1.8 preoperatively and 2.1 ± 1.4 at the final follow-up (p < 0.05). The SSA angles at the final follow-up increased 2.2° compared to the preoperative values (p < 0.05). The mean FSH increased 2.4 mm from pre- to postoperatively, but decreased 2.7 mm from postoperatively to final follow-up. The cervical ROM was not obviously reduced at the final follow-up (p > 0.05) because only one level was fixed. There were three cases of cerebrospinal fluid leakage, one case of haematoma, and one case showed transient neurological deterioration.ConclusionsEnlarged ACDF is an effective procedure for treating selective patients with severe localised OPLL. Using this technique, the retrovertebral OPLL can be removed through a one-level diskectomy and a corpectomy can be avoided.Trial registrationThis study has been registered with the ResearchRegistry and the unique identifying number is researchregistry1365 (K2015-022-04). It was retrospectively registered at 21 June 2016 and the first participant to the trial was at 4 January 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-016-0449-z) contains supplementary material, which is available to authorized users.
Highlights
Severe localised ossification of the posterior longitudinal ligament (OPLL) should be directly removed by anterior approach, but the exposure during anterior cervical diskectomy and fusion (ACDF) is restricted and may increase the risk of a cerebrospinal fluid (CSF) leak
Inclusion criteria for this technique were as follows: (1) the retrovertebral OPLL was limited within half of the adjacent vertebral bodies (Fig. 1), and (2) the occupying rate (OR), defined as the maximum thickness of OPLL divided by anterior–posterior diameter of the bony spinal canal on axial CT image, was more than 50 %
Anterior cervical diskectomy and fusion (ACDF) is highly technically demanding because the limited operative space may increase the risk of CSF leak and iatrogenic neurological deterioration [2], and the retrovertebral OPLL below or above the disk level cannot be removed [3]
Summary
Severe localised ossification of the posterior longitudinal ligament (OPLL) should be directly removed by anterior approach, but the exposure during anterior cervical diskectomy and fusion (ACDF) is restricted and may increase the risk of a cerebrospinal fluid (CSF) leak. Localised OPLL, with ossified mass on the disk space or at the posterior margin of vertebral body [1], is an indication of anterior decompression. The exposure of the conventional diskectomy and intervertebral fusion is restricted, which may increase the risk of cerebrospinal fluid (CSF) leak and iatrogenic cord damage [2, 3]. Some surgeons prefer anterior corpectomy and fusion (ACCF) which is facilitated to extirpate the ossification [2, 4,5,6]. How to safely and effectively remove the severe ossification through onelevel diskectomy needs to be further studied
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
