Niu Jiawen, Zhang Cheng, Zhao Jie, Song Yang, Xu Wen, Dou Chuanhong, Gao Chunzheng, Zhao Yachao, Wu Dongjin
Department of Spine Surgery, The Second Hospital of Shandong University, 247 Beiyuan Road, Jinan, 250033, Shandong, China.
J Orthop Surg Res. 2025 Aug 12;20(1):755. doi: 10.1186/s13018-025-06174-4.
Surgically managing multilevel thoracic ossification of the posterior longitudinal ligament (mT-OPLL) remains technically challenging. Recently, a novel technique called thoracic controllable antedisplacement and fusion (TCAF) has been proposed as an encouraging procedure for this disorder. This study aimed to offer evidence regarding the safety and efficacy of TCAF surgery through a case series of mT-OPLL patients treated with this new technique.
Between August 2021 and May 2025, 3 consecutive cases of mT-OPLL treated by the TCAF surgery were retrospectively reviewed, and their surgery-related data and complications were collected. Additionally, the modified Japanese Orthopedic Association (mJOA) score, American Spinal Injury Association (ASIA) grade, and imaging parameters, including the type, involved levels, maximal thickness (mT) and maximal occupation ratio (mOR) of T-OPLL, spinal canal area (SCA) and diameter (SCD) at the narrowest level, and antedisplacement distance (AD) of the thoracic column, were evaluated before surgery and/or at the final follow-up.
TCAF surgeries were successfully conducted in all patients (1 male and 2 females), and the average surgical level, operation time, blood loss, and hospitalization length were 8.33 ± 1.53, 530.00 ± 105.36 min, 600.00 ± 100.00 ml, and 20.00 ± 6.25 days, respectively. The mean mT and T-OPLL were 7.73 ± 1.05 mm and 7.67 ± 2.08, respectively. The average AD was 5.90 ± 0.20 mm. At the last visit, each patient achieved solid bony fusion with improved mOR, SCA and SCD. The average mJOA scores at the final visit were relatively greater than that before the operation (8.00 ± 1.00 vs. 3.67 ± 1.15), with a mean recovery rate of 59.72 ± 8.67%. In addition, the ASIA grades at the last visit improved in 2 patients but remained unchanged in 1 patient. No neurological deterioration or other serious complications occurred postoperatively, except for 1 case of cerebrospinal fluid leakage.
The TCAF procedure, which allows canal decompression with no need for removal of T-OPLL, could be a promising surgical alternative for safely and effectively managing mT-OPLL.
手术治疗多节段胸椎后纵韧带骨化症（mT-OPLL）在技术上仍然具有挑战性。最近，一种名为胸椎可控前移融合术（TCAF）的新技术被提出，作为治疗这种疾病的一种令人鼓舞的手术方法。本研究旨在通过一系列接受这种新技术治疗的mT-OPLL患者病例，提供有关TCAF手术安全性和有效性的证据。
回顾性分析2021年8月至2025年5月期间连续3例接受TCAF手术治疗的mT-OPLL患者，收集其手术相关数据和并发症。此外，评估术前和/或末次随访时的改良日本骨科协会（mJOA）评分、美国脊髓损伤协会（ASIA）分级以及影像学参数，包括T-OPLL的类型、累及节段、最大厚度（mT）和最大占位比（mOR）、最窄节段的椎管面积（SCA）和直径（SCD）以及胸椎的前移距离（AD）。
所有患者（1例男性和2例女性）均成功进行了TCAF手术，平均手术节段、手术时间、失血量和住院时间分别为8.33±1.53个节段、530.00±105.36分钟、600.00±100.00毫升和20.00±6.25天。平均mT和T-OPLL分别为7.73±1.05毫米和7.67±2.08。平均AD为5.90±0.20毫米。在末次随访时，每位患者均实现了牢固的骨融合，mOR、SCA和SCD均有所改善。末次随访时的平均mJOA评分相对高于术前（8.00±1.00对3.67±1.15），平均恢复率为59.72±8.67%。此外，2例患者末次随访时的ASIA分级有所改善，1例患者保持不变。术后除1例脑脊液漏外，未发生神经功能恶化或其他严重并发症。
TCAF手术无需切除T-OPLL即可实现椎管减压，可能是安全有效治疗mT-OPLL的一种有前景的手术选择。
