Ye Sheng, Yi Jiang-Bi, Li De-Li, Wu Fu-Jun, Ji Wen-Jun, Du Qian, Xin Zhi-Jun
Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
Neurosurg Rev. 2025 Sep 18;48(1):650. doi: 10.1007/s10143-025-03812-7.
Cervical ossification of the posterior longitudinal ligament (OPLL) causes spinal cord compression due to spinal canal stenosis. Traditional anterior approaches such as anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) have limitations, including restricted decompression range, extensive vertebral resection trauma, or insufficient stability. This study aimed to evaluate the efficacy and safety of a novel surgical technique-Anterior Cervical V-Slot Decompression and Fusion (ACVDF)-for treating long-segment OPLL. A retrospective analysis was conducted on 30 patients with multilevel OPLL who underwent ACVDF between December 2021 and March 2024. A curved grinding drill was used to precisely remove portion of the vertebral body and ossified tissue (≤ 50% of the sagittal diameter) through the V-shaped distracted intervertebral space, achieving direct decompression of long-segment OPLL During surgery. Postoperative follow-up 14.70 ± 1.62 months (12-18 months). Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and imaging methods such as CT and MRI. All 30 patients successfully completed the surgery, with a mean operative time of 143.17 ± 10.96 min and intraoperative blood loss of 177.67 ± 49.45 ml. At the final follow-up, the JOA score improved from 8.50 ± 1.96 to 14.67 ± 0.71 (P < 0.05), with an excellent and good rate of 90.00%. The VAS score decreased from 6.53 ± 1.53 to 1.30 ± 0.79 (P < 0.05). The spinal canal occupancy rate decreased from 42.13 to 10.61% (P < 0.05). The Height of the fused segments was 62.70 ± 13.58 mm at 1 week postoperatively and increased to 62.94 ± 13.99 mm at the final follow-up (P > 0.05). Cervical range of motion (ROM) decreased from 51.57 ± 8.96° preoperatively to 33.07 ± 6.18° at the final follow-up (P < 0.05). The fusion rate reached 100% at the final follow-up. No complications such as dural tears or spinal cord injuries occurred during surgery. ACVDF can achieve direct decompression of long-segment OPLL while preserving anterior column structures, maintaining cervical stability, and getting favorable clinical outcomes. This technique provides a new safe and effective treatment option for long-segment OPLL.
颈椎后纵韧带骨化症（OPLL）由于椎管狭窄导致脊髓受压。传统的前路手术，如颈椎前路椎间盘切除融合术（ACDF）和颈椎前路椎体次全切除融合术（ACCF）存在局限性，包括减压范围受限、椎体切除创伤大或稳定性不足。本研究旨在评估一种新型手术技术——颈椎前路V形槽减压融合术（ACVDF）治疗长节段OPLL的有效性和安全性。对2021年12月至2024年3月期间接受ACVDF手术的30例多节段OPLL患者进行回顾性分析。使用弯磨钻通过V形撑开的椎间隙精确切除部分椎体和骨化组织（矢状径≤50%），在手术中实现长节段OPLL的直接减压。术后随访14.70±1.62个月（12 - 18个月）。采用日本骨科协会（JOA）评分、视觉模拟量表（VAS）评分以及CT和MRI等影像学方法评估临床疗效。所有30例患者均成功完成手术，平均手术时间为143.17±10.96分钟，术中出血量为177.67±49.45毫升。末次随访时，JOA评分从8.50±1.96提高至14.67±0.71（P < 0.05），优良率为90.00%。VAS评分从6.53±1.53降至1.30±0.79（P < 0.05）。椎管占位率从42.13%降至10.61%（P < 0.05）。融合节段高度术后1周时为62.70±13.58毫米，末次随访时增至62.94±13.99毫米（P > 0.05）。颈椎活动度（ROM）术前为51.57±8.96°，末次随访时降至33.07±6.18°（P < 0.05）。末次随访时融合率达100%。手术过程中未发生硬膜撕裂或脊髓损伤等并发症。ACVDF可在保留前柱结构的同时实现长节段OPLL的直接减压，维持颈椎稳定性，并获得良好的临床疗效。该技术为长节段OPLL提供了一种新的安全有效的治疗选择。
