Lu Qilin, Li Xugui, Zhang Bin, Shi Jiangang, Sun Jingchuan
Department of Orthopedic Surgery, Spine Center, The Affiliated Hospital of Wuhan Sports University, Wuhan, China.
Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Orthop Surg. 2025 Aug;17(8):2479-2485. doi: 10.1111/os.70093. Epub 2025 Jun 8.
Anterior controllable antedisplacement and fusion (ACAF) is an effective strategy in treating cervical ossification of the posterior longitudinal ligament (C-OPLL). The controllable antedisplacement of the vertebrae-OPLL complex (VOC) through screws is both the most critical and technically challenging procedure, especially in osteoporosis (OP) condition. This study aims to introduce a modified method to significantly improve the procedure of VOC antedisplacement in ACAF.
The modified ACAF was used to treat 22 patients both with C-OPLL and OP from January 2020 to January 2023. The cohort comprised 17 females and 5 males, with an age of 60.68 ± 1.2 years (50-71 years). During this modified ACAF, bone cement was injected into the VOC, and the corresponding steps of grooving were improved. Japanese Orthopedic Association (JOA) score, complications, and fusion conditions were documented. A paired t-test was used to compare the changes before and after surgery.
Twenty-two C-OPLL patients were successfully treated by the modified ACAF. The operation time was 270.5 ± 14.8 min, and the intraoperative blood loss volume was 303.6 ± 13.0 mL. All patients were followed up for 26.55 months on average. The JOA score with 12.18 ± 1.68 at the last follow-up was significantly improved (vs. 8.59 ± 1.89 of presurgery, p < 0.05). No cement leakage was found during the augmentation, and 0.4 mL of bone cement was injected in each VOC, which obviously enhanced screws anchorage. All VOCs were successfully hoisted after the augmentation without screw loosening. Twenty-two C-OPLL patients achieved satisfactory fusion at the last visit.
Bone cement augmentation with modified steps of grooving can effectively assist the VOC antedisplacement in ACAF for OP group and has potential instantaneous revision ability for the intraoperative screw loosening for no-OP group.
前路可控椎体前移融合术（ACAF）是治疗颈椎后纵韧带骨化症（C-OPLL）的有效策略。通过螺钉实现椎体-后纵韧带复合体（VOC）的可控前移是最关键且技术难度最大的步骤，尤其是在骨质疏松（OP）情况下。本研究旨在介绍一种改良方法，以显著改善ACAF中VOC前移的操作。
采用改良ACAF治疗2020年1月至2023年1月期间22例C-OPLL合并OP患者。该队列包括17名女性和5名男性，年龄为60.68±1.2岁（50 - 71岁）。在改良ACAF过程中，向VOC内注入骨水泥，并改进了相应的开槽步骤。记录日本骨科学会（JOA）评分、并发症及融合情况。采用配对t检验比较手术前后的变化。
22例C-OPLL患者通过改良ACAF成功治疗。手术时间为270.5±14.8分钟，术中失血量为303.6±13.0毫升。所有患者平均随访26.55个月。末次随访时JOA评分为12.18±1.68，较术前的8.59±1.89有显著改善（p < 0.05）。强化过程中未发现骨水泥渗漏，每个VOC注入0.4毫升骨水泥，明显增强了螺钉的锚固力。强化后所有VOC均成功提升，无螺钉松动。22例C-OPLL患者末次随访时融合效果满意。
采用改良开槽步骤的骨水泥强化可有效辅助OP组在ACAF中进行VOC前移，对非OP组术中螺钉松动具有潜在的即时翻修能力。
