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Zhang Y, Huang Z, Xu P, Xu Z, Xing X, Xin Y, Gao M, Li X, Xiao Y. Comparison of Anterior Controllable Antedisplacement and Fusion Versus Laminoplasty in the Treatment of Multisegment Ossification of Cervical Posterior Longitudinal Ligament: A Meta-Analysis of Clinical. World Neurosurg 2024; 185:193-206. [PMID: 38157983 DOI: 10.1016/j.wneu.2023.12.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study aims to provide a comprehensive summary of the existing literature and conduct a systematic evaluation of the clinical outcomes associated with anterior controllable antedisplacement and fusion (ACAF) and posterior laminoplasty (LP) for the treatment of multisegment ossification of the cervical posterior longitudinal ligament (OPLL). METHODS We conducted an electronic search of databases, including PubMed, Embase, Cochrane Library, and CNKI, from the inception of the initial database to March 2023. We analyzed various parameters, including demographic data, operation time, intraoperative blood loss, cervical curvature, Japanese Orthopaedic Association (JOA) scores, Visual Analog Scale (VAS) scores, and postoperative complications. Two independent reviewers screened the literature, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using RevMan 5.4 software. RESULTS Our evaluation encompassed 7 studies involving a total of 467 patients. The patient cohort was divided into 2 groups: Group A (ACAF) comprised 226 patients, while Group B (LP) comprised 241 patients. Overall, our statistical analysis revealed significant differences between the 2 groups (P < 0.05) in terms of intraoperative blood loss, operative time, JOA score, JOA score improvement rate, postoperative VAS score, postoperative cervical curvature, and the incidence of certain postoperative complications (C5 nerve root paralysis, dysphagia, and axial symptoms). However, there was no statistically significant difference in the incidence of postoperative cerebrospinal fluid leakage and postoperative total complications between the 2 groups (P > 0.05). CONCLUSIONS The findings of this study suggest that, in the treatment of multilevel cervical OPLL, ACAF yields superior outcomes compared to LP. Specifically, ACAF improves postoperative neurologic function, reduces postoperative pain, lowers intraoperative blood loss, improves postoperative cervical curvature, and decreases the incidence of C5 nerve root paralysis and postoperative axial symptoms. Nonetheless, ACAF is associated with longer operative times and a higher incidence of postoperative dysphagia, though the overall incidence of postoperative complications is similar. It is important to note that these conclusions should be interpreted cautiously due to the limited sample size and the variable quality of the included studies. Further research involving larger, high-quality studies is warranted to validate these findings.
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Affiliation(s)
- Yiming Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Zhen Huang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Peng Xu
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Zhentao Xu
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Xiaohui Xing
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Yexin Xin
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China; School of Clinical Medicine, Weifang Medical University, Weifang, Shangdong, China
| | - Mingxu Gao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Xueyuan Li
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China
| | - Yilei Xiao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shangdong, China.
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Yan C, Zhao TY, Ji CL, Shi GD, Guo YF, Sun JC, Shi JG. Anterior controllable antedisplacement and fusion: quantitative analysis of a single surgeon's learning experience. Spine J 2022; 22:941-950. [PMID: 35038573 DOI: 10.1016/j.spinee.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior controllable antedisplacement and fusion (ACAF) is a novel surgical technique for the treatment of ossification of the posterior longitudinal ligament (OPLL) but the surgical learning curve for this technique has not been previously characterized. PURPOSE The aim of this study was to quantify a surgeon's learning curve for ACAF and the effect of surgeon experience on postoperative outcomes. STUDY DESIGN Prospective study of a single institution and single surgeon experience with ACAF surgery. PATIENT SAMPLE A total of 70 consecutive patients with OPLL undergoing ACAF surgery by a single, non-ACAF trained surgeon between 2017 and 2020 were analyzed. OUTCOME MEASURES Intraoperative and postoperative outcomes (blood loss, operative time, errors of surgical procedure, length of hospital stay, Japanese Orthopedic Association (JOA) scoring system, and surgical complications) were assessed. METHODS We prospectively reviewed the first 70 ACAF procedures between 2017 and 2020 performed by a single, non-ACAF trained surgeon. The function relationship between the operative time and case number was fitted using a locally weighted scatterplot smoothing (LOESS) plot. Spearman's correlation analysis was performed to determine factors affecting the operative time. The operative time-related learning curve for ACAF was established and difficulty of each procedure was assessed using a cumulative sum (CUSUM) model. The association between the specific errors of surgical procedures and surgeon experience was further analyzed. A modified CUSUM model was also used to establish the surgical procedure-related learning curve, and thus whether these two learning curves matched with each other was observed. Postoperative outcomes in relation to surgeon experience was compared using a Wilcoxon rank sum test and Chi-squared test. RESULTS Operative time presented a specific pattern of fewer patient-dependent changes as the case number increased. Spearman's correlation analysis showed the operative time was more affected by the case number (r=-0.73) than the complexity of condition and number of levels hoisted. The operative time-related CUSUM model identified the early (first 29 cases) and late phase (late 41 cases) of the learning process, which was also confirmed by a modified CUSUM model based on surgical procedure. The critical point of the CUSUM model for bilateral osteotomies was at case number 29, and time reduction after the early phase was approximately 34 minutes. Length of hospital stay and blood loss were less during the late phase than during the early phase (p<.05). Although no significant difference was observed in postoperative JOA scores between two phases, patients in the late phase obtained higher recovery rates of neurologic function than those in the early phase (p<.01). There was significant difference in the number of specific errors between the two phases (p=.02). There were no significant differences in overall complication rates between two phases, but a higher incidence of certain complications caused by specific errors was observed in the early phase (p=.02), including CSF leakage, C5 palsy and incomplete decompression. CONCLUSIONS We described, for the first time, a detailed learning curve for ACAF surgery. About 29 cases were needed to achieve mastery of ACAF. Once mastered, the surgeon could deal with various OPLL presentations in a universal way regardless of condition complexity and number of surgical levels. Bilateral osteotomies were the most difficult part of ACAF and produced the greatest reduction in time after mastery. We found a close association between specific errors of surgical procedure for ACAF and surgeon experience. Furthermore, certain complications caused by these errors should be on the alert during the early phase of learning ACAF, including CSF leakage, C5 palsy and incomplete decompression.
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Affiliation(s)
- Chen Yan
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Rd, Shanghai 200003, People's Republic of China
| | - Tian-Yi Zhao
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Rd, Shanghai 200003, People's Republic of China
| | - Cheng-Long Ji
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Rd, Shanghai 200003, People's Republic of China
| | - Guo-Dong Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Rd, Shanghai 200003, People's Republic of China
| | - Yong-Fei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Rd, Shanghai 200003, People's Republic of China
| | - Jing-Chuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Rd, Shanghai 200003, People's Republic of China.
| | - Jian-Gang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Rd, Shanghai 200003, People's Republic of China.
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Sun J, Sun K, Chen Y, Wang Y, Xu X, Shi J. Anterior Cervical Controllable Antedisplacement and Fusion (ACAF): Improving Outcomes for Severe Cervical Ossification of the Posterior Longitudinal Ligament. JBJS Essent Surg Tech 2022; 12:ST-D-20-00056. [PMID: 36741044 PMCID: PMC9889282 DOI: 10.2106/jbjs.st.20.00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Anterior cervical controllable antedisplacement and fusion (ACAF) is utilized for the treatment of symptomatic ossification of the posterior longitudinal ligament (OPLL). The aims of the procedure are to directly relieve ventral compression of the spinal cord, to reconstruct the spinal canal and restore cervical alignment, and to achieve satisfactory clinical recovery. Description The detailed steps to perform ACAF have been described previously1. Briefly, following induction of general endotracheal anesthesia, a standard right- or left-sided Smith-Robinson incision is made. Discectomies are performed at the involved levels. By measuring the thickness of the OPLL on an axial preoperative computed tomography scan at each compressed level, the amount of each anterior vertebral body to be resected can be calculated preoperatively. This was, in general, equal to the thickness of the ossified mass at the same level. The previously calculated portion of each involved body in the vertebral body-OPLL complex is resected. Following the creation of a contralateral longitudinal osseous trough, the prebent anterior cervical plate is then placed, and the screws are installed after proper drilling and taping on the remaining vertebral bodies. The screws utilized in this procedure should not be too short to achieve adequate purchase in the vertebral body. Subsequently, the intervertebral cages are inserted. Thus, the vertebral body-OPLL complex is temporarily stabilized for the next procedure. Next, an ipsilateral longitudinal osseous trough is created to completely isolate the vertebral body-OPLL complex. Notably, the objective of complete isolation of the vertebral body-OPLL complex is to further anteriorly hoist the complex to decompress the spinal cord. Finally, screws are inserted through the plate and into each vertebral body and are gradually tightened to displace the bodies anteriorly. Allogenic iliac bone graft is placed in the longitudinal bone troughs to promote fusion. Alternatives Nonoperative treatment is frequently ineffective. Traditional surgical interventions have included anterior cervical corpectomy and fusion (ACCF), posterior laminoplasty, and laminectomy2,3. ACCF focuses on resecting the ventral ossified mass in order to obtain direct decompression; however, this technique is very technically demanding, with a high risk of complications. In addition, the clinical benefits of ACCF will be limited when the OPLL extends over >3 levels. Posterior decompression can achieve indirect decompression by allowing the spinal cord to float away from the ossified mass. This technique depends largely on the preoperative presence of cervical lordosis and is contraindicated in patients with kyphosis or severe OPLL. In addition, posterior decompression surgery has been associated with a high incidence of late neurological deterioration and even revision surgery2. Rationale ACAF combines the advantages of direct decompression as occurs with ACCF with the limited manipulation of the canal contents as occurs with the posterior approach4-6. The procedure considers the ossified mass and the vertebral body as a single unit. Decompression is accomplished by moving the vertebral body with the OPLL ventrally away from the spinal cord. The preserved part of the vertebral body-OPLL complex becomes part of the anterior wall of the spinal canal. Without direct instrument manipulation inside the canal, the occurrence of cerebrospinal fluid leakage, hemorrhage, and intraoperative neural injury can be minimized5. Compared with a posterior approach, ACAF can achieve more decompression of the cord, especially in patients with cervical kyphosis and those with >60% of the spinal canal occluded6. Expected Outcomes This procedure can yield satisfactory clinical outcomes with fewer surgery-related complications1,4-6,9. A single-center, prospective, randomized controlled study showed significantly better Japanese Orthopaedic Association scores and recovery rates at 1 year for ACAF compared with laminoplasty for the treatment of multilevel OPLL in cases in which the occupying ratio of the canal was >60% occluded or the K-line (i.e., a virtual line between the midpoints of the anteroposterior canal diameter at C2 and C7) was negative9. In addition, patients who underwent ACAF had better preservation of cervical lordosis and sagittal balance9. Important Tips The cervical segments to be treated should include all of the segments with OPLL that are causing spinal cord compression.The uncinate process can be utilized as a safe anatomical landmark for the longitudinal osteotomies in order to avoid vertebral artery injury, even in cases with severely ossified masses.Careful evaluation of the vertebral artery on preoperative magnetic resonance imaging or computed tomography is of great importance.Appropriately increasing the curvature of the cervical plate can further enlarge the space for the following antedisplacement of the vertebral body-OPLL complex.The location of the uncinate processes must be confirmed before the creation of the 2 longitudinal osseous troughs7,8.The preserved superior and inferior vertebral end plates should be made as smooth and mutually parallel as possible.The thickness of the anterior part of the vertebral bodies to be resected should be calculated preoperatively.The posterior longitudinal ligament behind the involved segments should not be resected. Acronyms and Abbreviations ACAF = anterior cervical controllable antedisplacement and fusionACCF = anterior cervical corpectomy and fusionOPLL = ossification of the posterior longitudinal ligamentCT = computed tomographyJOA = Japanese Orthopaedic AssociationMRI = magnetic resonance imagingOR = occupying rate of the spinal canalVOC = vertebral bodies-OPLL complexRR = recovery rateCSF = cerebrospinal fluidUP = uncinate processTF = transverse foramen.
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Affiliation(s)
- Jingchuan Sun
- Spine Center, Department of Orthopedic Surgery, Changzheng Hospital, Shanghai, People’s Republic of China
| | - Kaiqiang Sun
- Spine Center, Department of Orthopedic Surgery, Changzheng Hospital, Shanghai, People’s Republic of China
| | - Yu Chen
- Spine Center, Department of Orthopedic Surgery, Changzheng Hospital, Shanghai, People’s Republic of China
| | - Yuan Wang
- Spine Center, Department of Orthopedic Surgery, Changzheng Hospital, Shanghai, People’s Republic of China
| | - Ximing Xu
- Spine Center, Department of Orthopedic Surgery, Changzheng Hospital, Shanghai, People’s Republic of China
| | - Jiangang Shi
- Spine Center, Department of Orthopedic Surgery, Changzheng Hospital, Shanghai, People’s Republic of China,Email for corresponding author:
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Luo X, Wang S, Sun K, Sun J, Wang Y, Jiang J, Zhao F, Guo Y, Shi J. Anterior Controllable Antedisplacement and Fusion (ACAF) Technique for the Treatment of Multilevel Cervical Spondylotic Myelopathy With Spinal Stenosis (MCSMSS): A Retrospective Study of 54 Cases. Clin Spine Surg 2021; 34:322-330. [PMID: 34379608 DOI: 10.1097/bsd.0000000000001144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 11/07/2020] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS), compared with hybrid decompression fixation (HDF). SUMMARY OF BACKGROUND DATA A retrospective analysis of 94 cases with MCSMSS was carried out. Fifty-four patients were treated with ACAF, whereas 40 patients were treated with HDF. METHODS The operation time, intraoperative blood loss, postoperative complications, Japanese Orthopedic Association score, Neck Disability Index score, parameters at axial computed tomography, cervical curvature and the Kang grade were compared between 2 groups. RESULTS The patients were followed up for 12-17 (15.6±1.6) months. Compared with HDF, ACAF group achieved better decompression according to computed tomography measurement and Kang grade (P<0.05), and recovered to a greater cervical Cobb angle (P<0.05). However, Japanese Orthopedic Association score and Neck Disability Index showed no significant difference 1 year after surgery (P>0.05). In addition, ACAF presented longer operation time (P<0.05) and similar intraoperative blood loss (P>0.05), compared with HDF. In terms of complications, ACAF produced less incidences of cerebrospinal fluid leakage, implant complication, epidural hematoma, and C5 palsy compared with HDF. CONCLUSIONS ACAF is an effective method for the treatment of MCSMSS. In comparison to HDF, ACAF has the advantages of more sufficient decompression, more satisfactory cervical curvature, and lower incidence rates of complications.
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Affiliation(s)
- Xi Luo
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Shunmin Wang
- Department of Orthopedics, 910 Hospital, Quanzhou, China
| | - Kaiqiang Sun
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Jingchuan Sun
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Yuan Wang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Jialin Jiang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Feng Zhao
- Department of Orthopedics, 910 Hospital, Quanzhou, China
| | - Yongfei Guo
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
| | - Jiangang Shi
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai
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Wang L, Luo HT, Lu W, Cai XB, Yu C, Lu S. Reliability and reproducibility of measurements in para-sagittal planes on sub-axial cervical vertebral bodies: a morphometric study of endplates in three-dimensional models. J Orthop Surg Res 2021; 16:503. [PMID: 34399792 PMCID: PMC8365898 DOI: 10.1186/s13018-021-02648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background Dimensional measurements have been implemented on a variety of entities in morphological studies of the sub-axial cervical vertebral endplate. Despite great progress, little information between the mid-sagittal plane and bilateral uncinate processes has been acquired due to the lack of a reliable method to determine the para-sagittal planes. Also, few studies of this region are available. We proposed a new approach to defining the para-sagittal planes on a 3D cervical vertebral body model; in this approach, dimensions can be measured in a specific plane. The aim of this study was to assess the inter-observer and intra-observer reliability of the measurements in different sagittal planes on sub-axial cervical vertebral endplates of 3D models. Methods We established mid-sagittal and bilateral quarter para-sagittal planes on the 3D model of a sub-axial cervical vertebral body based on landmarks labeled on the surface. By intersecting the vertebral body with the planes, three curves located at the three para-sagittal planes were generated. Linear dimensions were measured on every curve by two observers separately, and in total, 24 sub-axial cervical spines were included in the study. The first observer (O1) performed the procedure twice with an interval of 2 weeks. The paired t test, Wilcoxon matched-pairs signed-rank test and the interclass correlation coefficient (ICC) were employed to evaluate the inter- and intra-observer reliability of the proposed method. Results There were no significant differences in most intra- and inter-observer comparisons, and higher non-significant proportions were found in the intra-observer comparisons than in comparisons between different observers. The interclass correlation coefficients (ICCs) in the measurements were excellent (> 0.75) in most circumstances, and the values in intra-observer comparisons were higher than those in inter-observer comparisons. Conclusions In this study, we proposed an approach to determine the bilateral quarter para-sagittal planes in a 3D cervical vertebral body model; the results demonstrated that the method is reproducible with high intra- and inter-observer agreement.
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Affiliation(s)
- Long Wang
- Postgraduate College of Kunming Medical University, No.1168 Chunrong Xi Road, Chenggong District, Kunming, China
| | - Hao T Luo
- Department of Orthopaedics, The First People's Hospital of Yunnan Province, No.157, Jinbi Rd, Kunming, Yunnan, China.,Key Laboratory of Digital Orthopedics of Yunnan Province, No.157, Jinbi Rd, Kunming, Yunnan, China
| | - Wei Lu
- Department of Orthopaedics, The First People's Hospital of Yunnan Province, No.157, Jinbi Rd, Kunming, Yunnan, China
| | - Xing Bo Cai
- Postgraduate College of Kunming Medical University, No.1168 Chunrong Xi Road, Chenggong District, Kunming, China
| | - Chen Yu
- Postgraduate College of Kunming Medical University, No.1168 Chunrong Xi Road, Chenggong District, Kunming, China
| | - Sheng Lu
- Department of Orthopaedics, The First People's Hospital of Yunnan Province, No.157, Jinbi Rd, Kunming, Yunnan, China. .,Key Laboratory of Digital Orthopedics of Yunnan Province, No.157, Jinbi Rd, Kunming, Yunnan, China.
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Sun XF, Wang Y, Sun JC, Xu XM, Kong QJ, Chen Y, Yang HS, Liu Y, Guo YF, Shi GD, Chen XS, Chen DY, Shen Y, Hao DJ, Shen HX, Zhu QS, Yuan W, Jia LS, Shi JG. Consensus statement on diagnosis and treatment of cervical ossification of posterior longitudinal ligament from Asia Pacific Spine Society (APSS) 2020. J Orthop Surg (Hong Kong) 2021; 28:2309499020975213. [PMID: 33355038 DOI: 10.1177/2309499020975213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The study aimed to develop an evidence-based expert consensus statement on diagnosis and treatment of cervical ossification posterior longitudinal ligament (OPLL). METHOD Delphi method was used to perform such survey, and the panel members from Asia Pacific Spine Society (APSS) 2020 were invited to answer the open-ended questions in rounds 1 and 2. Then the results were summarized and developed into a Likert-style questionnaire for voting in round 3, and the level of agreement was defined as 80%. In the whole process, we conducted a systematic literature search on evidence for each statement. RESULTS Cervical OPLL can cause various degrees of neurological symptoms, an it's thought to be more common in Asia population. CT reconstruction is an important imaging examination to assist diagnosis and guide surgical choice. Segmental, continuous, mixed, and focal type is the most widely used classification system. The non-surgical treatment is recommended for patients with no or mild clinical symptoms, or irreversible neurological damage, or failed surgical decompression, or condition cannot tolerant surgery, or refusing surgery. As OPLL may continue to develop gradually, surgical treatment would be considered in their course inevitably. The surgical choice should depend on various conditions, such as involved levels, thickness, and type of OPLL, skill-experiences of surgeons, which are listed and discussed in the article. CONCLUSION In this statement, we describe the clinical features, classifications, and diagnostic criteria of cervical OPLL, and review various surgical methods (such as their indications, complications), and provide a guideline on their choice strategy.
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Affiliation(s)
- Xiao-Fei Sun
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yuan Wang
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Jing-Chuan Sun
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Xi-Ming Xu
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Qing-Jie Kong
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yu Chen
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Hai-Song Yang
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yang Liu
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yong-Fei Guo
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Guo-Dong Shi
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Xiong-Sheng Chen
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - De-Yu Chen
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Yong Shen
- Department of Spine Surgery, Hebei Medical University, The Third Hospital, Shijiazhuang, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Xi'an Jiaotong University and Xi'an Medical College, Xi'an Honghui Hospital, Xi 'an, China
| | - Hong-Xing Shen
- Department of Spine Surgery, Shanghai Jiaotong University, Renji Hospital, Shanghai, China
| | - Qing-San Zhu
- Department of Spine Surgery, Jilin University, The First Bethune Hospital, Changchun, China
| | - Wen Yuan
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Lian-Shun Jia
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
| | - Jian-Gang Shi
- Department of Spine Surgery, Second Military Medical University, Changzheng Hospital, Shanghai, China
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Analysis of the Incompletely Hoisted Vertebrae in the Anterior Controllable Antedisplacement and Fusion Surgery: Causes and Prevention. Clin Spine Surg 2021; 34:125-131. [PMID: 32815852 DOI: 10.1097/bsd.0000000000001037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 04/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Anterior controllable antedisplacement and fusion (ACAF) has been reported to be a safe and effective technique. However, incompletely hoisted vertebrae (IV) were found in the postoperative images. This study aims to analyze the causes and prevention of IV. METHODS The ACAF-treated case series subjects were retrospectively reviewed. The vertebrae were separated into the IV group and completely hoisted vertebrae (CV) group according to the gap between the vertebrae and plate. The radiographic data, degree of cervical lordosis, bone mineral density, number of hoisted vertebrae, operative time, blood loss, and Japanese Orthopaedic Association score were compared between the patients with IV and the patients without IV. RESULTS A total of 248 vertebrae were hoisted in the enrolled patients. Intervertebral disc height in the IV group was 3.7±0.4 mm, which is significantly lower than that in the CV group. The anterior or posterior overhanging lip, osteoporosis, and oblique osteotomy troughs and hinges existing after osteotomy were found to be impingements preventing the hoisting of the vertebrae. There were no differences in the age, sex, degree of cervical lordosis, number of hoisted vertebrae, and neurological improvement rate between the groups of patients with and without IV. CONCLUSIONS Lower intervertebral space height and impingements preventing hoisting were found to be possible causes of IV in ACAF. Measures to prevent the problem should be carried out.
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Yan C, Jia HC, Tan HY, Yu XW, Li M, Zhou XY, Yang MY, Song DW, Zhao QH, Li GZ, Tang SH, Yu BS, Li LT, Sun JC, Shi JG. 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. [PMID: 32966909 DOI: 10.1016/j.spinee.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/31/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior controllable antedisplacement and fusion (ACAF) is a novel surgical technique for the treatment of ossification of the posterior longitudinal ligament (OPLL). Its prognostic factors for decompression have not been well studied. Additionally, no detailed radiological standard has been set for hoisting the vertebrae-OPLL complex (VOC) in ACAF. PURPOSE To identify the possible prognostic factors for decompression outcomes after ACAF for cervical OPLL, to determine the critical value of radiological parameters for predicting good outcomes, and to establish a radiological standard for hoisting the VOC in ACAF. STUDY DESIGN This was a retrospective multicenter study. PATIENT SAMPLE A total of 121 consecutive patients with OPLL who underwent ACAF at a point between January 2017 and June 2018 at any one of seven facilities and were monitored for at least 1 year afterward were enrolled in a multicenter study. OUTCOME MEASURES Japanese Orthopedic Association (JOA) scores, recovery rate (RR) of neurologic function, and surgical complications were used to determine the effectiveness of ACAF. METHODS Patients were divided into two groups according to their RR for neurologic function. Patients with an RR of ≥50% and an RR of <50% were designated as having good and poor decompression outcomes, respectively. The relationship between various possible prognostic factors and decompression outcomes was assessed by univariate and multivariate analysis. The receiver operating characteristic curve was used to determine the optimal cutoff value of the radiological parameters for prediction of good decompression outcomes. Next, the patients were redivided into three groups according to the cutoff value of the selected radiological parameter (postoperative anteroposterior canal diameter [APD] ratio). Patients with postoperative APD ratios of ≤80.7%, 80.7%-100%, and ≥100% were defined as members of the incomplete, optimal, and excessive antedisplacement groups, respectively. Differences in decompression outcomes among the three groups were compared to verify the reliability of the postoperative APD ratio and assess the necessity of excessive antedisplacement. RESULTS Multivariate logistic regression analysis showed that patients' age at surgery (odds ratio [OR]=1.18; 95% confidence interval [CI]=1.08-1.29; p<.01) and postoperative APD ratio (OR=0.83; 95% CI=0.77-0.90; p<.01) were independently associated with decompression outcomes. The optimal cutoff point of the postoperative APD ratio was calculated at 80.7%, with 86.2% sensitivity and 73.5% specificity. There were no significant differences in the postoperative JOA scores and RRs between the excessive antedisplacement group and optimal antedisplacement group (p>.05). However, a lower incidence of cerebrospinal fluid leakage and screw slippage was observed in the optimal antedisplacement group (p<.05). CONCLUSIONS Patients' age at surgery and their postoperative APD ratio are the two prognostic factors of decompression outcomes after ACAF. The postoperative APD ratio is also the most accurate radiological parameter for predicting good outcomes. Our findings suggest that it is essential for neurologic recovery to restore the spinal canal to more than 80.7% of its original size (postoperative APD ratio >80.7%), and restoration to less than its original size (postoperative APD ratio <100%) will help reduce the incidence of surgical complications. This may serve as a valuable reference for establishment of a radiological standard for hoisting the VOC in ACAF.
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Affiliation(s)
- Chen Yan
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Huai-Cheng Jia
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Hao-Yuan Tan
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Xue-Wei Yu
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
| | - Ming Li
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433
| | - Xiao-Yi Zhou
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433
| | - Ming-Yuan Yang
- Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433
| | - Dian-Wen Song
- Department of Spine Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, 85 Wujin Rd, Shanghai, China, 200080
| | - Qing-Hua Zhao
- Department of Spine Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, 85 Wujin Rd, Shanghai, China, 200080
| | - Guo-Zheng Li
- Department of Orthopedics, Linzhou Hospital of Traditional Chinese Medicine, 244 Taihang Rd, Linzhou, China, 456550
| | - Sheng-Hui Tang
- Department of Orthopedics, Fifth Hospital of Southern Medical University, Southern Medical University, 566 Congcheng Ave, Guangzhou, China, 510900
| | - Bin-Sheng Yu
- Department of Spine Surgery, Shenzhen Hospital of Beijing University, 1120 Lianhua Rd, Shenzhen, China, 518036
| | - Lin-Tao Li
- Department of Spine Surgery, General Hospital of Nanjing Military Command, 305 East Zhongshan Rd, Nanjing, China, 210000
| | - Jing-Chuan Sun
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001.
| | - Jian-Gang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001
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Zhang B, Sun J, Xu X, Shi J, Guo Y, Sun K, Yang H, Wang Y, Huan L, Sun X, Wang H, Zheng B, Chen F, Zhang P. Skip corpectomy and fusion (SCF) versus anterior controllable antedisplacement and fusion (ACAF): which is better for patients with multilevel cervical OPLL? Arch Orthop Trauma Surg 2019; 139:1533-1541. [PMID: 30953139 DOI: 10.1007/s00402-019-03182-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The aim of this study was to compare the clinical efficacy and radiological outcomes of skip corpectomy and fusion (SCF) with anterior controllable antedisplacement and fusion (ACAF) for treating multilevel ossification of the posterior longitudinal ligament (OPLL). METHODS 62 patients with multilevel OPLL who had undergone SCF or ACAF were analyzed retrospectively. Types of OPLL, occupying ratio (OR), Japanese Orthopaedic Association (JOA) score, Recovery Rate (RR), Neck Disability Index (NDI) score, Cobb's angles of C2-C7, operation time, blood loss, hospital stay, ratings for fusion assessment and complications were recorded and assessed. RESULTS Postoperative C2-C7 Cobb's angle (11.1 ± 3.2° vs. 13.7 ± 2.5°; P < 0.05), NDI scores at final follow-up (14.3 ± 1.6 vs. 13.3 ± 1.3; P < 0.05), and rate of cerebral fluid (CSF) leakage (5, 16.7% vs. 0,0%; P < 0.05) were significantly better in the ACAF group. At 6 months, bone graft fusion rate was significantly greater in the ACAF group (24.75% vs. 15.50%; P < 0.05). CONCLUSIONS Surgical treatment of multilevel OPLL by SCF or ACAF showed no significant differences in clinical outcomes, with the exception of better NDI scores at final follow-up in ACAF. In addition, ACAF is better than SCF in terms of early bone graft fusion rate, lordotic curvature improvement, risk of CSF leakage.
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Affiliation(s)
- Bin Zhang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Ximing Xu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Yongfei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Haisong Yang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Le Huan
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiaofei Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Haibo Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Bing Zheng
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Fangni Chen
- Department of Radiology and Nuclear Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Peng Zhang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China
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Kong QJ, Sun XF, Wang Y, Sun JC, Sun PD, Lv HD, Wang ZQ, Xu XM, Guo YF, Shi JG. Risk assessment of vertebral artery injury in anterior controllable antedisplacement and fusion (ACAF) surgery: a cadaveric and radiologic study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2417-2424. [PMID: 31428861 DOI: 10.1007/s00586-019-06111-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE We have introduced a novel surgery technique named anterior controllable antedisplacement and fusion (ACAF) for the treatment of ossification of the posterior longitudinal ligament. As reported, the satisfactory postoperative outcome can be attributed to the larger decompression width. However, it may associate with high prevalence of vertebral artery injury (VAI) theoretically. Thus, assessment of the vulnerability of vertebral artery in ACAF is of great importance. METHODS Computed tomographic scan data of 28 patients were retrospectively studied. Seven radiographic parameters were evaluated: uncinate process (UP) tips distance, transverse foramen (TF)-UP tips distance, TF-LWL (the ipsilateral limited wedging line) distance, the limited distance of lateral decompression, the maximum oblique angle of LWL, TF-LWG (the lateral wall of groove) distance, and width of groove. Eleven fresh cadaveric spines undergoing ACAF surgery were also studied. Two anatomic parameters were evaluated: width of groove and LWG-TF distance. RESULTS The UP tips distance increased from C3 to C6 and tended to be larger in males. The UP tip-TF distance and LWL-TF distance were smallest at C4, but both were larger than 2 mm. Maximum oblique angle decreased from C3 to C6. Postoperatively, both radiographic and cadaveric measurements showed the width of groove was larger than UP tips distance, but LWG-TF distance was larger than 2 mm in all levels. CONCLUSION UP can be used as anatomical landmarks to avoid VAI during ACAF surgery. Radiographic and cadaveric measurements verified the safety of ACAF surgery, even for those cases with wedging and lateral slotting.
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Affiliation(s)
- Qing-Jie Kong
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiao-Fei Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Jing-Chuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Pei-Dong Sun
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, Southern Medical University, No. 1023 Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China
| | - Hong-di Lv
- The 990th Hospital of People's Liberation Army, No. 1 Fenghuang Road, Zhumadian, 463000, Henan Province, People's Republic of China
| | - Zi-Qin Wang
- Henan Provincial Corps Hospital of Chinese People's Armed Police Forces, No. 1 Kangfu Zhong Street, Zhengzhou, 450000, Henan Province, People's Republic of China
| | - Xi-Ming Xu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yong-Fei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jian-Gang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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Sun J, Xu X, Wang Y, Yuan X, Shi J, Yang H, Guo Y, Kong Q, Wang Y, Sun K, Zhao Q. How to Avoid Postoperative Remaining Ossification Mass in Anterior Controllable Antedisplacement and Fusion Surgery. World Neurosurg X 2019; 3:100034. [PMID: 31225525 PMCID: PMC6584598 DOI: 10.1016/j.wnsx.2019.100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To retrospectively review the cases with ossification of the posterior longitudinal ligament (OPLL) treated with anterior controllable antedisplacement and fusion (ACAF). Patients with postoperative remaining ossification mass (PROM) are analyzed to figure out the causes and preventions of this problem. METHODS A total of 115 patients were included. PROM was identified as remaining OPLL existed in the spinal canal other than included in the vertebral-OPLL complex on postoperative computed tomography. The Japanese Orthopaedic Association scoring system was used to evaluate the neurologic status. Surgery-related complications such as cerebrospinal fluid (CSF) leakage and spinal cord or nerve injury were all recorded. The patients with the PROM group and those without the PROM group were compared. RESULTS There were 14 patients with wide-base OPLL (12.2%) and 10 patients (8.7%) with PROM among the 115 patients with OPLL. The 10 patients with PROM were all with wide-base OPLL. The average improvement rate of Japanese Orthopaedic Association score in patients without PROM was significantly larger than that in patients with PROM (69.5 ± 22.6% vs. 36.7 ± 22.0, P < 0.01). Incidence rate of postoperative CSF leakage and neural deterioration were significantly higher in patients with PROM than that in patients without PROM (CSF leakage, 40.0% vs. 5.9%; neural deterioration, 50.0% vs. 3.0%). No other complications were observed. CONCLUSIONS The occurrence of PROM might cause complications and poor neural function recovery in patients treated with ACAF. Surgical techniques should be noted to avoid PROM in ACAF surgery.
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Key Words
- ACAF, Anterior controllable antedisplacement and fusion
- Anterior controllable antedisplacement and fusion
- CSF, Cerebrospinal fluid
- CT, Computed tomography
- Complication
- IR, Improvement rate
- JOA, Japanese Orthopaedic Association
- MRI, Magnetic resonance imaging
- OPLL, Ossification of the posterior longitudinal ligament
- Ossification of the posterior longitudinal ligament
- PROM, Postoperative remaining ossification mass
- Postoperative remaining ossification mass
- VOC, Vertebral-OPLL complex
- WBO, Wide-base OPLL
- Wide-base OPLL
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Affiliation(s)
| | | | | | | | - Jiangang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China
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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. [DOI: 10.1016/j.wneu.2018.10.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 11/22/2022]
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Yang H, Xu X, Shi J, Guo Y, Sun J, Shi G, Wang Y. Anterior Controllable Antedisplacement Fusion as a Choice for Ossification of Posterior Longitudinal Ligament and Degenerative Kyphosis and Stenosis: Postoperative Morphology of Dura Mater and Probability Analysis of Epidural Hematoma Based on 63 Patients. World Neurosurg 2019; 121:e954-e961. [DOI: 10.1016/j.wneu.2018.10.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 01/30/2023]
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14
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Sun JC, Sun KQ, Sun SX, Xu XM, Wang Y, Kong QJ, Yang HS, Guo YF, Shi GD, Shi JG. Computer-assisted virtual operation planning in anterior controllable anterior-displacement and fusion surgery for ossification of the posterior longitudinal ligament based on actual computed tomography data. Clin Neurol Neurosurg 2018; 177:86-91. [PMID: 30634057 DOI: 10.1016/j.clineuro.2018.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the effect of computer-assisted virtual operation planning (CAVOP) on anterior controllable anterior-displacement and fusion (ACAF) surgery for ossification of the posterior longitudinal ligament (OPLL). PATIENTS AND METHODS A total of 25 patients with OPLL were enrolled in the study from September 2017 to December 2017. Preoperative Computed tomography (CT) scanning data were input into Mimics software to reconstruct three-dimensional (3D) models of actual cervical OPLL.Preoperative simulation of each surgical procedure and measurement of main parameters for intraoperative decision were conducted. Postoperative CT were used to test the clinical value of the preoperative planning. Width of vertebrae-OPLL complex (VOC), thickness of resected vertebral body (VB), height of intervertebral spacer, and length of screws and anterior plate were analyzed. RESULTS There were no significant differences between the length of screws, width of VOC, and thickness of anterior resection of vertebrae in preoperative CT and postoperative CT. Statistical differences were found between preoperative and postoperative height of intervertebral space and length of anterior plate. CONCLUSION A virtual ACAF surgical procedure for OPLL is feasible and useful clinically in surgical planning. It may provide a valuable tool for surgeons in formulating an appropriate surgical plan.
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Affiliation(s)
- Jing-Chuan Sun
- Department of Orthopedic Surgery,Spine Center,Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai 200003,People's Republic of China
| | - Kai-Qiang Sun
- Department of Orthopedic Surgery,Spine Center,Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai 200003,People's Republic of China
| | - Shuang-Xi Sun
- Department of Spine Surgery, Weihai Central Hospital, Shandong, China
| | - Xi-Ming Xu
- Department of Orthopedic Surgery,Spine Center,Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai 200003,People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery,Spine Center,Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai 200003,People's Republic of China
| | - Qing-Jie Kong
- Department of Orthopedic Surgery,Spine Center,Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai 200003,People's Republic of China
| | - Hai-Song Yang
- Department of Orthopedic Surgery,Spine Center,Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai 200003,People's Republic of China
| | - Yong-Fei Guo
- Department of Orthopedic Surgery,Spine Center,Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai 200003,People's Republic of China
| | - Guo-Dong Shi
- Department of Orthopedic Surgery,Spine Center,Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai 200003,People's Republic of China.
| | - Jian-Gang Shi
- Department of Orthopedic Surgery,Spine Center,Changzheng Hospital, Second Military Medical University No.415 Fengyang Road, Shanghai 200003,People's Republic of China.
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Anterior Controllable Antedisplacement and Fusion as Revision Surgery After Posterior Decompression Surgery in Patients with Ossification of the Posterior Longitudinal Ligament. World Neurosurg 2018; 123:e310-e317. [PMID: 30496921 DOI: 10.1016/j.wneu.2018.11.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the surgical outcomes of anterior controllable antedisplacement and fusion (ACAF) as a revision surgery after posterior decompression surgery (PDS) in patients with ossification of the posterior longitudinal ligament (OPLL). METHODS From June 2016 to May 2017, 15 patients (7 men; 8 women) had undergone ACAF as revision after PDS. The Japanese Orthopaedic Association (JOA) score was used to evaluate the pre- and postoperative neurological function. The kappa line and complications were also evaluated. RESULTS The 15 patients were followed up for 15.1 ± 1.8 months (range, 12-18). The mean interval between the initial PDS and revision ACAF was 40.3 ± 11.3 months (range, 24-62). The JOA score improved from 8.9 ± 1.6 (range, 5-11) before revision ACAF to 13.9 ± 1.6 (range, 11-16) at the final follow-up evaluation (P < 0.05). The JOA recovery rate was 61.9% ± 15.8% (range, 37.5%-90.9%). The kappa line of 7 patients improved from negative values to positive values after ACAF. Five complications (33.3%) developed in 5 patients. No instrument failure or neurological deterioration was observed during the follow-up period. CONCLUSION In the present study, the outcomes of ACAF for revision surgery for OPLL were satisfactory. ACAF could improve neurological function significantly and is an alternative surgical procedure for revision of PDS for OPLL.
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Anterior Controllable Antedisplacement Fusion as a Choice for Degenerative Cervical Kyphosis with Stenosis: Preliminary Clinical and Radiologic Results. World Neurosurg 2018; 118:e562-e569. [DOI: 10.1016/j.wneu.2018.06.239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022]
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Sun JC, Zhang B, Shi J, Sun KQ, Huan L, Sun XF, Liu N, Zheng B, Wang HB. Can K-Line Predict the Clinical Outcome of Anterior Controllable Antedisplacement and Fusion Surgery for Cervical Myelopathy Caused by Multisegmental Ossification of the Posterior Longitudinal Ligament? World Neurosurg 2018; 116:e118-e127. [DOI: 10.1016/j.wneu.2018.04.128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
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