Duan Wanru, Chou Dean, Jian Fengzeng, Chen Zan
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Oper Neurosurg. 2021 Feb 16;20(3):E221. doi: 10.1093/ons/opaa376.
The anterior decompression technique, including vertebral body sliding osteotomy1 and anterior controllable antedisplacement fusion (ACAF),2 treats ossified posterior longitudinal ligament (OPLL) without actual excision of the OPLL.3 The fundamental strategy is to separate the mid-portion of the vertebral body along with the OPLL using bilateral anterior osteotomies followed by controllable antedisplacement. These techniques restore the space of the spinal canal anteriorly by anterior translation of the OPLL, avoiding excision and dural manipulation.4 We illustrate the case of a patient who had failed laminoplasty and the surgical decision making for ACAF. We discuss the other surgical options regarding patient selection, present preoperative and postoperative imaging, to demonstrate the efficacy of ACAF and show strategies of ACAF to make it a safe and effective procedure. We demonstrate our technique of ACAF using the intraoperative microscope and models in this video to illustrate the steps of ACAF. A written consent to the procedure was obtained from the patient.
前路减压技术，包括椎体滑动截骨术1和前路可控前移融合术（ACAF）2，在不实际切除后纵韧带骨化（OPLL）的情况下治疗OPLL。3其基本策略是通过双侧前路截骨术将椎体中部与OPLL分离，然后进行可控前移。这些技术通过OPLL的前路平移从前路恢复椎管空间，避免切除和硬膜操作。4我们展示了一例椎板成形术失败患者的病例以及ACAF的手术决策。我们讨论了关于患者选择的其他手术方案，展示了术前和术后影像学检查，以证明ACAF的疗效，并展示ACAF的策略，使其成为一种安全有效的手术。在本视频中，我们使用术中显微镜和模型展示了我们的ACAF技术，以说明ACAF的步骤。已获得患者对该手术的书面同意。
