Wang Shunmin, Liu Dong, Li Jincui, Sun Jingchuan, Li Tiefeng, Shi Jiangang
Department of Orthopedic Surgery, The Spine Surgical Center, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
Department of Urology, Shanghai Changzheng Hospital, Shanghai, China.
J Orthop. 2025 Jun 4;70:158-165. doi: 10.1016/j.jor.2025.05.044. eCollection 2025 Dec.
The conventional anterior method for addressing multi-segmental severe ossification of cervical posterior longitudinal ligament (OPLL) is challenging and carries significant risks. Anterior controllable antedisplacement and fusion (ACAF) is a novel surgical technique for the treatment of cervical OPLL. This study aims to assess the enhancement and preservation of cervical lordosis and sagittal alignment following ACAF for patients with multi-segmental severe cervical OPLL.
A total of 69 patients with multi-segmental severe cervical OPLL were enrolled, of whom 44 patients underwent ACAF, and 25 underwent traditional anterior cervical corpectomy and fusion (ACCF). Preoperative, postoperative, and the final follow-up radiographs were utilized to evaluate improvements in cervical lordosis and sagittal alignment among patients. The following parameters were measured: C0-2 lordosis, C2-7 lordosis, segmental coriander, C2-7 sagittal vertical axis (SVA), T1 slope, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and Japanese Orthopedic Association (JOA) scores. Subgroup analyses were conducted for 21 patients undergoing single-level ACAF and 23 patients undergoing ACAF more than two levels. Additionally, outcomes for patients treated with single-level ACAF were compared with those who received single-level ACCF.
At the final following-up, patients receiving ACAF had improved C0-2 lordosis, C2-7 lordosis, segmental coriander and C2-7 SVA (all p values < 0.05). The C2-7 lordosis of patients from the ACAF group more than two levels was much better than those with single level. Although the improved segmental coriander postoperatively decreased at the final follow-up, the final segmental coriander of the patients in single-level ACAF group was much better than those in two or more level ACAF.
ACAF showed better therapeutic effects on the enhancement and preservation of cervical lordosis and sagittal alignment in patients with multi-segmental cervical OPLL.
传统的前路治疗多节段严重颈椎后纵韧带骨化症（OPLL）的方法具有挑战性且风险较大。前路可控前移融合术（ACAF）是一种治疗颈椎OPLL的新型手术技术。本研究旨在评估多节段严重颈椎OPLL患者接受ACAF治疗后颈椎前凸及矢状面排列的改善和维持情况。
共纳入69例多节段严重颈椎OPLL患者，其中44例行ACAF，25例行传统颈椎前路椎体次全切除融合术（ACCF）。利用术前、术后及末次随访X线片评估患者颈椎前凸及矢状面排列的改善情况。测量以下参数：C0-2前凸、C2-7前凸、节段性矢状面 Cobb角、C2-7矢状面垂直轴（SVA）、T1斜率、胸椎后凸、腰椎前凸、骶骨倾斜度、骨盆倾斜度及日本骨科学会（JOA）评分。对21例行单节段ACAF的患者和23例行两节段以上ACAF的患者进行亚组分析。此外，将单节段ACAF治疗患者的结果与接受单节段ACCF治疗的患者进行比较。
末次随访时，接受ACAF治疗的患者C0-2前凸、C2-7前凸、节段性矢状面 Cobb角及C2-7 SVA均有改善（所有p值<0.05）。两节段以上ACAF组患者的C2-7前凸明显优于单节段组。虽然术后改善的节段性矢状面 Cobb角在末次随访时有所下降，但单节段ACAF组患者的末次节段性矢状面 Cobb角明显优于两节段或以上ACAF组。
ACAF在多节段颈椎OPLL患者颈椎前凸及矢状面排列的改善和维持方面显示出更好的治疗效果。
