Anterior Controllable Antedisplacement and Fusion as Revision Surgery for the Treatment of OPLL after Anterior and Posterior Decompression: A Case Report

摘要: Abstract
Background 
In cases of cervical ossification of the posterior longitudinal ligament (OPLL), when initial anterior or posterior decompression fails to yield satisfactory results, the alternative approach is often chosen for revision surgery. Nevertheless, there is a lack of reported information regarding the treatment and prognosis of patients with complex OPLL who have undergone both anterior and posterior decompression but experienced relapse.
Case presentation
A 79-year-old male patient presented with numbness, weakness, and muscle atrophy in the right upper extremity, along with weakness in the right lower extremity. Initial assessment revealed a Japanese Orthopedic Association (JOA) score of 7. X-ray and CT scans showed C4-6 fusion following anterior cervical discectomy and fusion (ACDF), laminar changes at the right C3-5 level, continuous posterior longitudinal ligament ossification from C4 to C6, collapsed intervertebral metal fusion cages (C4-5 and C5-6), and cervical kyphosis. MRI confirmed spinal canal stenosis at C4-6. The patient previously underwent ACDF 25 years ago for spinal stenosis, followed by posterior laminectomy as revision surgery. After experiencing recurrent symptoms following a fall one year ago, the patient underwent a second revision surgery using anterior controllable antedisplacement and fusion (ACAF) technology, which led to symptom improvement, resulting in a postoperative JOA score of 14.
Conclusions
Treatment of OPLL patients with symptom recurrence after traditional anterior and posterior decompression is challenging. ACAF technology offers a viable solution for managing this complex case.