Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: ACAF showed better therapeutic effects on the enhancement and preservation of cervical lordosis and sagittal alignment in patients with multi-segmental cervical OPLL.