The CT Classification of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament to Guide Hybrid Anterior Controllable Antedisplacement and Fusion vs. Posterior Laminoplasty

Abstract

Objective: For precise and minimally invasive treatment of ossification of the posterior longitudinal ligament of the cervical spine, the lifting segment is minimized, anterior controllable antedisplacement and fusion (ACAF) was refined and improved. In addition, the development of appropriate surgical procedures for the ossification of each segment was rarely reported. Therefore, this study aimed to compare the efficacy and safety of hybrid anterior controlled antedisplacement fusion (Hybrid ACAF) with laminoplasty for multilevel ossification of the posterior longitudinal ligament (OPLL).

Methods: Between May 2018 and May 2021, 70 patients with multilevel OPLL were divided into a hybrid ACAF group and a laminoplasty group according to surgical methods. All patients were followed up for at least 1 year. Japanese Orthopaedic Association (JOA) score and recovery rate (JOARR), (VAS, NDI) score and C2–C7 Cobb angle, the sagittal vertical axis of the neck (SVA), and complications (cerebrospinal fluid leakage, C5 paralysis, etc.) were compared between the two groups by t test or non-parametric test.

Results: The operation time of hybrid ACAF was longer. C5 paralysis and axial pain were more common in the laminoplasty group, while dysphagia and hoarseness were more common in the hybrid ACAF group. At the last follow-up, the hybrid ACAF group had better recovery and maintenance of cervical lordosis and sagittal plane balance and a higher JOA score and recovery rate than the laminoplasty group.

Conclusions: Hybrid ACAF can reduce the number of vertebral bodies and expand the decompression range, which is safe, effective, and tailored to local conditions. Compared with laminoplasty, hybrid ACAF is a precise alternative for patients with OPLL.

Keywords

Hybrid Anterior Controllable Antedisplacement and Fusion / Complications / Laminoplasty / Ossification of Posterior Longitudinal Ligament

References

[1] Boody BS, Lendner M, Vaccaro AR. Ossification of the posterior longitudinal ligament in the cervical spine: a review. Int Orthop. 2019; 43: 797–805.

[2] Nayak NR, Piazza M, Milby A, Thawani JP, Smith LJ, Stein SC, et al. Surgical approaches for the treatment of multilevel cervical ossification of the posterior longitudinal ligament: results of a decision analysis. World Neurosurg. 2018; 112: e375–e384.

[3] Bernstein DN, Prong M, Kurucan E, Jain A, Menga EN, Riew KD, et al. National Trends and complications in the surgical Management of Ossification of the posterior longitudinal ligament (OPLL). Spine. 2019; 44: 1550–1557.

[4] Qin R, Chen X, Zhou P, Li M, Hao J, Zhang F. Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament: a meta-analysis. Eur Spine J. 2018; 27: 1375–1387.

[5] Sun K, Wang S, Sun J, Guo Y, Huan L, Xu X, et al. Analysis of the correlation between cerebrospinal fluid space and outcomes of anterior controllable Antedisplacement and fusion for cervical myelopathy due to ossification of the posterior longitudinal ligament. World Neurosurg. 2019; 122: e358–e366.

[6] Chen Y, Sun J, Yuan X, Guo Y, Yang H, Chen D, et al. Comparison of anterior controllable Antedisplacement and fusion with posterior Laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a prospective, randomized, and control study with at least 1-year follow up. Spine. 2020; 45: 1091–1101.

[7] Sun K, Wang S, Huan L, Sun J, Xu X, Sun X, et al. Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy. Eur Spine J. 2020; 29: 1001–1012.

[8] Yoshii T, Sakai K, Machino M, Furuya T. Choice of surgical procedure for cervical ossification of the posterior longitudinal ligament. J Clin Med. 2020;11:(18):5396.

[9] Shao T, Gu J, Zhu Y, Tang W, Li Q, Lu J, et al. Modified axial computed tomography classification of cervical ossification of the posterior longitudinal ligament: selecting the optimal operating procedure and enhancing the accuracy of prognosis. Quant Imaging Med Surg. 2021; 11: 1888–1898.

[10] Sun J, Sun K, Wang S, Yang H, Wang Y, Xu X, et al. “shelter technique” in the treatment of ossification of the posterior longitudinal ligament involving the C2 segment. World Neurosurg. 2019; 125: e456–e464.

[11] Lee DH, Lee SK, Cho JH, Hwang CJ, Lee CS, Yang JJ, et al. Efficacy and safety of oblique posterior endplate resection for wider decompression (trumpet-shaped decompression) during anterior cervical discectomy and fusion. J Neurosurg Spine. 2022; 38: 157–164.

[12] Hacker RJ, Cauthen JC, Gilbert TJ, Griffith SL. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine. 2000; 25: 2646–2654; discussion 2655.

[13] Moon BJ, Kim D, Shin DA, Yi S, Kim KN, Yoon DH, et al. Patterns of short-term and long-term surgical outcomes and prognostic factors for cervical ossification of the posterior longitudinal ligament between anterior cervical corpectomy and fusion and posterior laminoplasty. Neurosurg Rev. 2019; 42: 907–913.

[14] Shi H, Chen L, Zhu L, Jiang ZL, Wu XT. Instrumented fusion versus instrumented non-fusion following expansive open-door laminoplasty for multilevel cervical ossification of the posterior longitudinal ligament. Arch Orthop Trauma Surg. 2022; 143(6): 2919–2927.

[15] Nagoshi N, Yoshii T, Egawa S, Sakai K, Kusano K, Tsutsui S, et al. Clinical indicators of surgical outcomes after Laminoplasty for patients with cervical ossification of the posterior longitudinal ligament: a prospective multicenter study. Spine. 2022; 47: 1077–1083.

[16] Yan C, Jia HC, Tan HY, Yu XW, Li M, Zhou XY, et al. How much space of the spinal canal should be restored by hoisting the vertebrae-OPLL complex for sufficient decompression in anterior controllable antedisplacement and fusion? A multicenter clinical radiological study. Spine J. 2021; 21: 273–283.

[17] Kong QJ, Sun XF, Wang Y, Sun PD, Sun JC, Ouyang J, et al. New anterior controllable antedisplacement and fusion surgery for cervical ossification of the posterior longitudinal ligament: a biomechanical study. J Neurosurg Spine. 2022; 37: 4–12.

[18] Sun K, Wang S, Sun J, Wang H, Huan L, Sun X, et al. Surgical outcomes after anterior controllable Antedisplacement and fusion compared with single open-door Laminoplasty: preliminary analysis of postoperative changes of spinal cord displacements on T2-weighted magnetic resonance imaging. World Neurosurg. 2019; 127: e288–e298.

[19] Nakajima H, Watanabe S, Honjoh K, Kitade I, Sugita D, Matsumine A. Long-term outcome of anterior cervical decompression with fusion for cervical ossification of posterior longitudinal ligament including postsurgical remnant ossified spinal lesion. Spine. 2019; 44: E1452–e1460.

[20] Jia Z, Mo Z, Ding F, He Q, Fan Y, Ruan D. Hybrid surgery for multilevel cervical degenerative disc diseases: a systematic review of biomechanical and clinical evidence. Eur Spine J. 2014; 23: 1619–1632.

[21] Wu TK, Meng Y, Liu H, Wang BY, Hong Y, Rong X, et al. Biomechanical effects on the intermediate segment of noncontiguous hybrid surgery with cervical disc arthroplasty and anterior cervical discectomy and fusion: a finite element analysis. Spine J. 2019; 19: 1254–1263.

[22] Huang K, Wang H, Liu H, Meng Y, Ding C, Wang B, et al. Classification of three-level hybrid surgery for the treatment of cervical degenerative disc disease: a retrospective study of 108 patients. BMC Surg. 2022; 22: 179.

[23] Hirai T, Yoshii T, Sakai K, Inose H, Yuasa M, Yamada T, et al. Anterior cervical Corpectomy with fusion versus anterior hybrid fusion surgery for patients with severe ossification of the posterior longitudinal ligament involving three or more levels: a retrospective comparative study. J Clin Med. 2021;15;10(22);5315

[24] Hussain M, Nassr A, Natarajan RN, An HS, Andersson GB. Relationship between biomechanical changes at adjacent segments and number of fused bone grafts in multilevel cervical fusions: a finite element investigation. J Neurosurg Spine. 2014; 20: 22–29.

[25] Yan C, Zhao TY, Ji CL, Shi GD, Guo YF, Sun JC, et al. Anterior controllable antedisplacement and fusion: quantitative analysis of a single surgeon’s learning experience. Spine J. 2022; 22: 941–950.

[26] Kawaguchi Y, Urushisaki A, Seki S, Hori T, Asanuma Y, Kimura T. Evaluation of ossification of the posterior longitudinal ligament by three-dimensional computed tomography and magnetic resonance imaging. Spine J. 2011; 11: 927–932.

[27] Sun X, Li F, Zhao B, Zhang B, Sun K, Sun J, et al. A clinical classification of cervical ossification of the posterior longitudinal ligament to guide surgical strategy. Spine (Phila Pa 1976). 2024; 49: 239–246.

[28] Kawaguchi Y, Matsumoto M, Iwasaki M, Izumi T, Okawa A, Matsunaga S, et al. New classification system for ossification of the posterior longitudinal ligament using CT images. J Orthop Sci. 2014; 19: 530–536.

RIGHTS & PERMISSIONS

2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.