540° Cervical Realignment Procedure for Extensive Cervical OPLL With Kyphotic Deformity

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedic Surgery

Background:

• Surgical management of extensive cervical ossification of the longitudinal ligament (OPLL) with kyphotic deformity presents challenges.
• Anterior approaches risk neurological injury and dural defects, while posterior approaches may yield incomplete decompression and suboptimal outcomes.

Purpose of the Study:

• To present a novel, two-stage posterior-anterior-posterior (P-AP) 540° surgical technique.
• To evaluate the safety and efficacy of this P-AP 540° procedure for extensive cervical OPLL with kyphotic deformity.

Main Methods:

• Retrospective analysis of patients undergoing the two-stage P-AP 540° procedure.
• Stage 1 involved posterior laminectomy, facet release, and segmental screw fixation.
• Stage 2 included anterior cervical discectomy and fusion at the deformity apex, followed by posterior fusion.

Main Results:

• Eighteen patients (15 male, 3 female, mean age 64.5 years) were analyzed with a mean follow-up of 30 months.
• Significant improvements were observed in cervical alignment (C2-C7 Cobb angle from 10.5° to -12.2°), canal occupying ratio (73.5% to 38.4%), and K-line distance.
• Patient-reported outcomes, including Neck Disability Index and Japanese Orthopedic Association scores, showed significant improvement.

Conclusions:

• The 540° P-AP procedure offers a safe and effective surgical option for extensive cervical OPLL with kyphotic deformity.
• This technique provides effective decompression, cervical realignment, and favorable clinical outcomes.
• It potentially mitigates the disadvantages associated with conventional anterior or posterior-only surgical approaches.