Guan Jian, Li Kang, Yuan Chenghua, Duan Wanru, Wang Kai, Liu Zhenlei, Wang Zuowei, Wang Xingwen, Wu Hao, Jian Fengzeng, Chen Zan
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China.
Neurospine. 2024 Sep;21(3):994-1003. doi: 10.14245/ns.2448086.043. Epub 2024 Sep 30.
The anterior controllable antedisplacement and fusion (ACAF) technique is a new procedure for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) that requires management of the disc adjacent to the ossification. This study describes a novel technique to reduce the number of fixed segments, namely, the "Klotski technique." The efficacy of ACAF using the Klotski technique was compared with that of anterior cervical corpectomy and fusion (ACCF) in the treatment of OPLL with en bloc type dural ossification (DO).
The clinical data of 25 patients with severe OPLL and en bloc type DO who were treated by the ACAF Klotski technique or ACCF at our hospital from January 2020 to January 2022 were retrospectively analyzed. In the Klotski technique, the number of segments fused within the OPLL is limited. The antedisplacement space was designed according to the shape of the vertebrae-OPLL-DO complex (VODC). Then, the entire VODC was antedisplaced as in Klotski. Neurological function and image examination were assessed preoperatively and postoperatively. Complications associated with surgery were recorded.
Patients were followed up for 24-36 months. There were 11 patients who were treated with ACAF and 14 patients who were treated with ACCF. At 2 weeks after surgery, the incidence of neurological deterioration was 21.4% (3 of 14) in the ACCF group and 9.1% (1 of 11) in the ACAF group. The incidence of intraoperative cerebrospinal fluid leakage (CFL) was 35.7% (5 of 14) in the ACCF group and 9.1% (1 of 11) in the ACAF group. The postoperative follow-up JOA scores of the patients in both groups were significantly better than their preoperative JOA scores (p<0.05).
The Klotski technique for ACAF is a good option for the treatment of patients with en bloc type OPLL-DO, as it limits the number of fused segments, has a low incidence of CFL and neurologic deficits and is associated with good neurological recovery.
前路可控前移融合术（ACAF）是一种治疗颈椎后纵韧带骨化症（OPLL）的新手术，该手术需要处理与骨化相邻的椎间盘。本研究描述了一种减少固定节段数量的新技术，即“Klotski技术”。比较采用Klotski技术的ACAF与颈椎前路椎体次全切除融合术（ACCF）治疗整块型硬脊膜骨化（DO）型OPLL的疗效。
回顾性分析2020年1月至2022年1月在我院接受ACAF Klotski技术或ACCF治疗的25例重度OPLL和整块型DO患者的临床资料。在Klotski技术中，OPLL内融合的节段数量有限。根据椎体-OPLL-DO复合体（VODC）的形状设计前移空间。然后，像在Klotski手术中一样将整个VODC前移。术前和术后评估神经功能和影像学检查。记录与手术相关的并发症。
患者随访24 - 36个月。11例患者接受了ACAF治疗，14例患者接受了ACCF治疗。术后2周，ACCF组神经功能恶化发生率为21.4%（14例中的3例），ACAF组为9.1%（11例中的1例）。ACCF组术中脑脊液漏（CFL）发生率为35.7%（14例中的5例），ACAF组为9.1%（11例中的1例）。两组患者术后随访JOA评分均显著优于术前JOA评分（p<0.05）。
ACAF的Klotski技术是治疗整块型OPLL-DO患者的一个良好选择，因为它限制了融合节段的数量，CFL和神经功能缺损的发生率低，并且神经功能恢复良好。
