Abstract
BackgroundThe concept of generous decompression, including resection of the posterior longitudinal ligament (PLL) and even partial bilateral uncovertebral joint resection, has been adopted by some authors. This was justified by the need to remove compressive structures hidden underneath and to prevent nerve root impingement during extreme flexion/extension or rotation. This study was designed to assess the benefits of PLL resection as a routine step in anterior cervical discectomy and fusion (ACDF) surgeries and to find out if there is any added risk of such a procedure that overweighs its benefits.MethodsThis is a retrospective study conducted on 50 patients who underwent ACDF for treatment of degenerative cervical intervertebral disc disease with microscopic resection of the posterior longitudinal ligament.ResultsThere were 31 (62%) males and 19 (38%) females. Age ranged from 22 to 69 years with a mean age of 47.32 years. A total of 83 disc levels were operated upon with a mean of 1.66 levels per patient. Analysis of the obtained data showed a statistically significant difference between the preoperative and both early and late postoperative VAS (p value < 0.001 for both). Moreover, there was a statistically significant difference between early and late postoperative VAS with a p value < 0.001. For axial neck pain, similar results could be demonstrated. Regarding motor function of related nerve roots, there was a statistically significant improvement in preoperative motor power grade values that can be demonstrated when compared with both the early and late postoperative grade values (3.96 ± 0.638, 4.34 ± 0.557, and 4.88 ± 0.328 respectively).ConclusionsDespite being an additional step in ACDF surgery, resection of the PLL does not seem to add significant surgical risk. On the other hand, it had a positive impact on outcome regarding axial and radicular pain. So, it may be advisable to attempt resection of the PLL as a routine step in ACDF surgery.
Highlights
The concept of generous decompression, including resection of the posterior longitudinal ligament (PLL) and even partial bilateral uncovertebral joint resection, has been adopted by some authors
Spondylotic disease of the cervical spine is considered a well-known cause of neurological dysfunction
In comparison to posterior approaches, Anterior cervical discectomy with fusion (ACDF) has the advantages of being easier to perform allowing a wider exposure of the disc space together with less patient discomfort [3]
Summary
The concept of generous decompression, including resection of the posterior longitudinal ligament (PLL) and even partial bilateral uncovertebral joint resection, has been adopted by some authors. This was justified by the need to remove compressive structures hidden underneath and to prevent nerve root impingement during extreme flexion/extension or rotation. This study was designed to assess the benefits of PLL resection as a routine step in anterior cervical discectomy and fusion (ACDF) surgeries and to find out if there is any added risk of such a procedure that overweighs its benefits. ACDF has been considered one of the most common surgical procedures in spinal surgery and a standard treatment for cervical radiculopathy and/or myelopathy [2]. A rate of complications ranging from 8 to 20% has been reported, mostly attributed to the surgical approach and surgical corridor (such as dysphagia, voice changes, hematoma, and recurrent laryngeal nerve palsy) [4]
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