OBJECTIVE: To investigate the technical key points and effectiveness of ultrasonic bone scalpel-assisted anterior controllable antedisplacement and fusion (ACAF) for treating cervical ossification of the posterior longitudinal ligament (OPLL). METHODS: Between June 2022 and December 2024, 11 OPLL patients underwent ultrasonic bone scalpel-assisted ACAF. The cohort included 8 males and 3 females, aged 49-74 years (mean, 56.7 years). The OPLL classification included 5 cases of mixed-type, 4 cases of segmental-type, and 2 cases of continuous-type cases. Ossification involved 2-5 spinal segments (mean, 3.2). Disease duration ranged from 2 to 18 months (mean, 6.2 months). The operation time, intraoperative blood loss, and complications were recorded. Pain improvement was assessed using the visual analogue scale (VAS) score, and neurological function was evaluated using Japanese Orthopaedic Association (JOA) score. Postoperative cervical CT and MRI were performed to measure spinal canal encroachment rate, spinal canal area, and spinal cord sagittal diameter. RESULTS: All operations were successfully completed. The operation time ranged from 174 to 360 minutes (mean, 255.9 minutes). The intraoperative blood loss ranged from 170 to 530 mL (mean, 345.9 mL). The C ₅ nerve root palsy occurred in 1 patient. No cerebrospinal fluid leakage, aggravated spinal cord injury, or recurrent/superior laryngeal nerve injuries occurred. All patients were followed 3-12 months (mean, 7.2 months). At last follow-up, VAS scores significantly decreased and JOA scores significantly increased compared to preoperative values ( P<0.05). According to the JOA improvement rate, the effectiveness was rated as excellent in 2 cases, good in 8, and fair in 1, with an excellent and good rate of 90.9%. Radiological re-examination revealed no implant loosening, screw breakage, or aggravated spinal stenosis. Postoperative spinal canal encroachment rate significantly decreased, while spinal canal area and spinal cord sagittal diameter significantly increased compared to preoperative measurements ( P<0.05). CONCLUSION For the treatment of cervical OPLL via ACAF, the intraoperative application of ultrasonic bone scalpel-assisted osteotomy enables precise vertebral groove creation and mobilization of the vertebra-ossification complex, thereby enhancing surgical safety and achieving satisfactory short-term effectiveness.
Humans ; Middle Aged ; Male ; Female ; Ossification of Posterior Longitudinal Ligament/diagnostic imaging* ; Aged ; Cervical Vertebrae/diagnostic imaging* ; Spinal Fusion/instrumentation* ; Treatment Outcome ; Ultrasonic Surgical Procedures/instrumentation* ; Operative Time

A 53-year-old man presented with acute cervical myelopathy following a fall. Cervical radiography and computed tomography showed ossification of the posterior longitudinal ligament (OPLL) from C2 to C6 level, with severe cervical canal stenosis and cord compression. Magnetic resonance imaging further showed increased T2-weighted signal in the spinal cord at the level of greatest central spinal canal stenosis. OPLL is a significant cause of myelopathy in Asian populations and is found in up to 25% of patients presenting with cervical compression myelopathy. The clinical presentation, radiological evaluation and management of OPLL are discussed.
Cervical Vertebrae ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; diagnostic imaging ; Spinal Cord ; diagnostic imaging ; Spinal Cord Compression ; diagnostic imaging ; Spinal Cord Diseases ; pathology ; Tomography, X-Ray Computed

OBJECTIVEUse sagittal reconstruction CT to verify the surgical strategy for cervical ossification of the posterior longitudinal ligament (OPLL).

METHODSA retrospective study of 161 patients (106 males and 55 females) who had undergone surgery for OPLL from July 2007 to November 2010 was performed. The mean age at surgery was 54.5 years (range from 26 to 77 years). The mean follow-up period was 28 months (12 - 54 months). There were 40 patients accept anterior approach surgeries (anterior group) which include 14 cases of anterior cervical corpectomy and fusion and 26 cases of anterior cervical discectomy and fusion. There were 120 patients accept posterior approach surgeries (posterior group) which was spinous process-splitting laminoplasty for cervical myelopathy using coralline hydroxyapatite. One patient accepted combined anterior and posterior approach. According to the sagittal reconstruction CT, the main reason for spinal cord compression was cervical disc herniation in anterior group, and OPLL in posterior group. The level of spinal cord compression was 1 to 2 levels in anterior group, and 1 to 5 levels in posterior group with a major of 2 to 4 levels. As the classification of OPLL, segmental type and circumscribed type were major of segmental type in anterior group and all of the four types were in posterior group, the distribution of each type was average. The patients of posterior group were classified into two groups according to the modified K-line classification, and clinical results were compared between the two groups. The modified K-line was defined as a line that connects the midpoints of the spinal canal at C(2) and C(7) on sagittal CT myelography. Compression to the spinal cord did not exceed the K-line in the modified K-line(+) group and did exceed it in the modified K-line(-) group. Clinical data were compared using t-test or χ(2) test. Correlation analysis was used to determine the relationships of C(2)-C(7) angulation between sagittal reconstruction CT and neutral position X-ray.

RESULTSThe patient of anterior group had better recovery rate of the JOA score (72% ± 27%) than the posterior group (59% ± 35%) at the latest follow-up (t = 2.238, P = 0.027). In posterior group, the patients of modified K-line(+) group had better recovery rate of the JOA score (63% ± 37%) than the K-line(-) group (49% ± 30%) at the latest follow up (t = 2.150, P = 0.034). The C(2)-C(7) angulation on sagittal reconstruction CT was 11° ± 9° which has significantly correlated with the C(2)-C(7) angulation on neutral position X-ray which was 10° ± 10° (r = 0.947, P < 0.01).

CONCLUSIONSConsidering the selection of surgical approach, it should be combined with the main clinical diagnosis for spinal cord compression, the level of compression, the classification of OPLL and the kyphotic alignment of the cervical spine. The modified K-line is a simple and practical tool for making decisions regarding the surgical strategy for cervical OPLL patients.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; diagnostic imaging ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

Female ; Humans ; Ligamentum Flavum ; diagnostic imaging ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; diagnostic imaging ; surgery ; Spinal Stenosis ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome