"Shelter technique" in the treatment of ossification of posterior longitudinal ligament involving C2 segment.

"Shelter technique" in the treatment of ossification of posterior longitudinal ligament involving C2 segment.

World Neurosurg. 2019 Jan 30;:

Authors: Sun J, Sun K, Wang S, Yang H, Wang Y, Xu X, Shi J

Abstract
PURPOSE: Anterior or posterior decompression has been widely used to treat patients with ossification of posterior longitudinal ligament (OPLL). However, when OPLL extends to C2 level, the complex anatomic structures around C2 vertebral body and postoperative destabilization or kyphosis would make it difficult to perform anterior or posterior surgery. This study proposed a novel technique named "shelter technique" to deal with C2-OPLL.
METHODS: Sixteen patients with cervical OPLL involving C2 segment were included. The OPLL below C2 was dealt with anterior controllable antedisplacement and fusion (ACAF), including discectomy of involved levels, resection of the anterior vertebral bodies, installation of the intervertebral cages and anterior cervical plate, isolation of vertebrae-OPLL complex (VOC), and the final hoisting of the VOC. when dealing with C2-OPLL, the posterior portion of C2 vertebral body was resected to create the "shelter" based on the thickness of C2-OPLL, which could provide space for further antedisplacement of ossified mass behind C2 vertebrae. Finally, OPLL behind C2 was moved forward together with the antedisplacement of VOC below C2.
RESULTS: Postoperative MRI and CT showed sufficient decompression of the spinal cord including C2 segment, and the "shelter" provided enough space for the antedisplacement of ossified mass behind C2 segment. At the final follow-up of one year, neurological function of all patients recovered significantly.
CONCLUSION: The shelter technique can be relatively effective and safe for patients with OPLL involving C2 segment. However, further studies with more cases and longer follow-up will be required to reveal the surgical value of the technique.

PMID: 30710725 [PubMed - as supplied by publisher]

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