Anterior Controllable Antedisplacement Fusion (ACAF) in Revision Surgery for Iatrogenic Cervical Kyphosis: Technical Note and Case Series

Abstract

Background: Iatrogenic cervical kyphosis (ICK) often requires complex anterior and posterior correction, which is associated with multiple complications. Consequently, there is a need to investigate alternative treatment approaches that streamline the operative process and markedly diminish postoperative complications. This study, therefore, aimed to evaluate the feasibility and efficacy of a single-stage anterior controllable antedisplacement fusion (ACAF) in revision surgeries for ICK.

Methods: A retrospective review was conducted on three ICK cases treated with the ACAF technique in our department from December 2023 to January 2024. The cohort comprised two females and one male. The medical records, symptoms, signs, imaging studies, and 3-month postoperative follow-up data were analyzed to preliminarily evaluate the surgery's feasibility and efficacy.

Results: The mean operative time was 222.0 ± 67.5 min, with an average blood loss of 83.3 ± 28.9 mL and an average hospital stay of 11.7 ± 2.9 days. No patient experienced severe complications, such as neurological damage, during surgery. Postoperatively, two patients experienced transient respiratory distress within 2–5 days, managed with low-dose methylprednisolone (80 mg daily) and supplemental oxygen via nasal cannula. At the 3-month follow-up, all patients showed significant symptom improvement and increased cervical Japanese Orthopedic Association scores. Radiographic assessments, including X-rays and computed tomography scans, demonstrated marked improvements in cervical curvature without evidence of screw loosening. Magnetic resonance imaging indicated significant dural sac expansion and alleviation of spinal cord compression.

Conclusion: The ACAF technique effectively corrects ICK, offering advantages such as reduced intraoperative blood loss, fewer complications, and shorter operative and hospitalization times compared to traditional combined anterior–posterior corrective approaches. It presents an effective alternative for surgeons performing revision corrective surgery for ICK.

Keywords

anterior controllable antedisplacement fusion / iatrogenic cervical kyphosis / revision surgery / single stage

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2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.