OBJECTIVE: To describe a surgical technique of anterior decompression and fusion using bone grafts obtained from cervical vertebral bodies with ossification of the posterior longitudinal ligament of the cervical spine. This technique seeks to avoid complications associated with an anterior approach of decompression and bone fusion, which widely uses autogenous bone from the iliac crest. METHODS: Forty patients with cervical myelopathy were studied. The ossified ligament was localized to one, two, three, four, five, six, and seven vertebral bodies in 10, 18, 5, 4, 1, 1, and 1 patients, respectively. The ossified area of all posterior longitudinal ligament was completely removed using microsurgical techniques, and 11 patients were operated on at one level, 21 at two levels, and 8 at three levels. RESULTS: The symptoms of all patients improved after the operation. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 3 years (range, 1-5.25 yr). Anterior angulation was found in one of eight patients (13%) who underwent three-level fusion. CONCLUSION: Two major advantages were as follows: 1) no complications related to the iliac donor site occurred, and 2) early mobilization of patients was possible with a soft cervical collar. Anterior decompression and fusion should be used for cases with ossification of up to three consecutive vertebrae needing either one- or two-level fusions.
OBJECTIVE: To describe a surgical technique of anterior decompression and fusion using bone grafts obtained from cervical vertebral bodies with ossification of the posterior longitudinal ligament of the cervical spine. This technique seeks to avoid complications associated with an anterior approach of decompression and bone fusion, which widely uses autogenous bone from the iliac crest. METHODS: Forty patients with cervical myelopathy were studied. The ossified ligament was localized to one, two, three, four, five, six, and seven vertebral bodies in 10, 18, 5, 4, 1, 1, and 1 patients, respectively. The ossified area of all posterior longitudinal ligament was completely removed using microsurgical techniques, and 11 patients were operated on at one level, 21 at two levels, and 8 at three levels. RESULTS: The symptoms of all patients improved after the operation. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 3 years (range, 1-5.25 yr). Anterior angulation was found in one of eight patients (13%) who underwent three-level fusion. CONCLUSION: Two major advantages were as follows: 1) no complications related to the iliac donor site occurred, and 2) early mobilization of patients was possible with a soft cervical collar. Anterior decompression and fusion should be used for cases with ossification of up to three consecutive vertebrae needing either one- or two-level fusions.
Authors: Lindsay Tetreault; Hiroaki Nakashima; So Kato; Michael Kryshtalskyj; Nagoshi Nagoshi; Aria Nouri; Anoushka Singh; Michael G Fehlings Journal: Global Spine J Date: 2018-08-15