Novel Technique as a Revision Surgery for Failed Anterior Cervical Corpectomy and Fusion in the Treatment of Cervical Myelopathy Due to Ossification of the Posterior Longitudinal Ligament

Abstract

This article aimed to introduce a novel technique, the "seesaw technique," for failed anterior cervical corpectomy and fusion (ACCF) in the treatment of cervical ossification of the posterior longitudinal ligament. A patient who underwent ACCF 12 years ago and suffered gradually deteriorating neurologic function was referred to our institution. Preoperative imaging showed residual ossified mass at C5/6 level, causing compression to his spinal cord. He patient was treated by the seesaw technique. The main surgical procedures include removal of the plate and screws, removal of the osteophytes and diskectomy of C4/5, resection of the anterior part of C5 vertebral body, establishment of a transverse hinge at C7 vertebral body, installation of cervical plate and hoisting tool, and antedisplacement of C5 vertebral body and titanium mesh. Images were investigated before and after the procedure. The Japanese Orthopaedic Association score was used to evaluate his neurologic function, and surgery-related complications were also analyzed. The patient acquired significant improvement of his neurologic function 2 days after the surgery, and he could walk by himself without assistance. Postoperative images showed his spinal canal was enlarged sufficiently and the compression at C5/6 level was also released. At 13 months follow-up, his Japanese Orthopaedic Association score increased from 9 before surgery to 14, with an improvement rate of 62.5%. No surgery-related complications were observed during the whole follow-up. The seesaw technique provides satisfactory outcomes with wide enough decompression window and serves as a safe, effective surgical alternative for patients with failed ACCF.