Modiﬁed ACDF Technique for the Treatment of Centrum Focal Ossiﬁcation of the Posterior Longitudinal Ligament: A Case Report

Orthopaedic Surgery, 2023 · DOI: 10.1111/os.13711 · Published: May 1, 2023

Simple Explanation

Anterior cervical discectomy fusion (ACDF) is a surgery for cervical spondylosis, but it has limits when the problem is in the center of the vertebra. This paper presents a case where a modified ACDF was used to treat a patient with OPLL located in the middle of the C5 vertebra. The modified ACDF procedure involves removing part of the vertebral body and the lesion directly to resolve spinal cord compression, potentially avoiding nerve injury.

Study Duration

45 days

Participants

One 72-year-old male

Evidence Level

Level 4, Case Report

Key Findings

1
Postoperative imaging showed that cervical curvature was recovered and spinal canal compression was relieved.
2
The patient's VAS score for neck pain decreased from 7 preoperatively to 1.5 at the last follow-up, while the JOA score increased from 10 preoperatively to 29 at the last follow-up.
3
The patient’s extremity muscle strength improved and muscle tension decreased after the modified ACDF procedure.

Research Summary

This case report introduces a modified ACDF technique for treating centrum focal OPLL, which occupies the central position of the vertebral body. The modified ACDF procedure involves resecting part of the C5 centrum and ossification, preserving most of the bony structure, and using internal fixation and fusion space. The study concludes that modified ACDF can be an effective surgical method for resolving spinal cord compression in a specific location, with good postoperative outcomes.

Practical Implications

Surgical Technique

Modified ACDF offers a viable surgical option for treating focal OPLL located in the middle of the vertebral body, where standard ACDF may be inadequate.

Minimally Invasive

The modified technique aligns with the concept of minimally invasive spinal surgery by directly addressing the source of compression while minimizing tissue disruption.

Bone Density Consideration

The study emphasizes the importance of evaluating bone mineral density before surgery to mitigate the risks of vertebral collapse and cage subsidence.

Study Limitations

1
The study is limited by being a single case report, which limits the generalizability of the findings.
2
Concerns exist regarding the long-term risks of vertebral body collapse and cage subsidence.
3
The need for multicenter, randomized controlled trials with longer follow-up periods to evaluate the feasibility of the new technique is highlighted.

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