Department of Orthopaedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Orthop Surg. 2022 Feb;14(2):331-340. doi: 10.1111/os.13181. Epub 2021 Dec 22.
To achieve the anatomical evaluation of spinal nerve and cervical intervertebral foramina in anterior controllable antedisplacement and fusion (ACAF) surgery, a novel surgical technique with the wider decompression, through a cadaveric and radiologic study.
Radiographic data of consecutive 47 patients (21 by ACAF and 26 by anterior cervical corpectomy and fusion [ACCF]) who have accepted surgery for treatment of cervical ossification of the posterior longitudinal ligament(OPLL) and stenosis from March 2017 to March 2018 were retrospectively reviewed and compared between an ACAF group and ACCF group. Three postoperative radiographic parameters were evaluated: the decompression width and the satisfaction rate of decompression at the entrance zone of intervertebral foramina on computed tomography (CT), and the transverse diameter of spinal cord in the decompression levels on magnetic resonance imaging (MRI). In the anatomic study, three fresh cadaveric spines (death within 3 months) undergoing ACAF surgery were also studied. Four anatomic parameters were evaluated: the width of groove, the distance between the bilateral origins of ventral rootlets, the length of ventral rootlet from their origin to the intervertebral foramina, the descending angle of ventral rootlet.
The groove created in ACAF surgery included the bilateral origins of ventral rootlets. The rootlets tended to be vertical from the rostral to the caudal direction as their takeoff points from the central thecal sac became higher and farther away from their corresponding intervertebral foramina gradually. No differences were identified between left and right in terms of the length of ventral rootlet from the origin to the intervertebral foramina and the descending angle of ventral rootlet. The decompression width was significantly greater in ACAF group (19.2 ± 1.2 vs 14.7 ± 1.2, 21.3 ± 2.2 vs 15.4 ± 0.9, 21.5 ± 2.1 vs 15.7 ± 1.0, 21.9 ± 1.6 vs 15.9 ± 0.8, from C to C ). The satisfactory rate of decompression at the entrance zone of intervertebral foramina tended to be better in the left side in ACAF group (significant differences were identified in the left side at C , C , C level, and in the right side at C level when compared with ACCF). And decompression width was significantly greater than the transverse diameter of spinal cord in ACAF group. Comparatively, there existed no significant difference in the ACCF group besides the C level.
ACAF can decompress the entrance zone of intervertebral foramina effectively and its decompression width includes the origins and massive running part of bilateral ventral rootlets. Due to its wider decompression range, ACAF can be used as a revision strategy for the patients with failed ACCF.
通过尸体和影像学研究，实现前路可控前移位融合术（ACAF）中脊柱神经和颈椎椎间孔的解剖评估，这是一种具有更广泛减压效果的新型手术技术。
回顾性分析 2017 年 3 月至 2018 年 3 月连续 47 例（ACAF 组 21 例，前路颈椎椎体次全切除融合术 [ACCF]组 26 例）接受手术治疗颈椎后纵韧带骨化（OPLL）和狭窄的患者的影像学资料，并将 ACAF 组与 ACCF 组进行比较。评估了 3 项术后影像学参数：CT 上椎间孔入口处的减压宽度和减压满意度，以及 MRI 上减压水平脊髓的横径。在解剖学研究中，还研究了 3 例接受 ACAF 手术的新鲜尸体脊柱（死亡时间在 3 个月内）。评估了 4 项解剖学参数：沟的宽度、双侧腹神经根起点之间的距离、腹神经根从起点到椎间孔的长度、腹神经根的下降角度。
ACAF 手术中形成的沟包括双侧腹神经根起点。随着腹神经根从中央脊索的起点升高并逐渐远离相应的椎间孔，其向头侧和尾侧的方向趋于垂直。从起源到椎间孔的腹神经根的长度和腹神经根的下降角度在左右两侧没有差异。ACAF 组的减压宽度明显大于 ACCF 组（C 到 C ：19.2±1.2 比 14.7±1.2，21.3±2.2 比 15.4±0.9，21.5±2.1 比 15.7±1.0，21.9±1.6 比 15.9±0.8）。ACAF 组椎间孔入口减压的满意度左侧倾向于更好（C 、C 、C 水平左侧差异有统计学意义，C 水平右侧差异有统计学意义）。ACAF 组的减压宽度明显大于脊髓的横径，而 ACCF 组除 C 水平外，差异无统计学意义。
ACAF 可有效减压椎间孔入口，其减压宽度包括双侧腹神经根的起点和大部分走行部。由于其更广泛的减压范围，ACAF 可作为 ACCF 失败患者的一种修正策略。
