Treatment of Ossification or Sclerosis of the Posterior Longitudinal Ligament of the Cervical Spine Using New Techniques

By Wendong Xie¹, Xiudong Liu¹, Chao Zhang²

Affiliations

1. Department of Orthopaedics, Gansu University of Chinese Medicine, Gansu, China
2. Department of Orthopaedics, Gansu Provincial Hospital, Gansu, China

doi: 10.29271/jcpsp.2025.07.939

Sir,

Ossification of the posterior longitudinal ligament of the cervical spine is a degenerative condition that often leads to the narrowing of the spinal canal as well as compression of the spinal cord and nerve roots. Symptoms include neck pain, limited mobility, limb numbness, and movement disorders. In severe cases, surgical treatment is required.¹ Subtotal anterior cervical vertebral body resection with decompression and fusion reduces spinal cord compression and is considered one of the best treatments for posterior longitudinal ligament ossification. However, it has the disadvantages of incomplete decompression, many complications, and high requirements for surgical techniques.² Anterior cervical vertebral ossification with anterior fusion of the vertebral body complex is a new technique for the treatment of posterior longitudinal ligament ossification of the cervical spine. This surgical approach can effectively relieve spinal stenosis and reduce the compression symptoms of the spinal cord.³ Additionally, avoiding the direct lifting of the spinal canal contents by surgical instruments can minimise the incidence of cerebrospinal fluid leakage, haemorrhage, and intraoperative nerve injury.⁴ The operating procedures  of  the  new  technique  are  described  in  detail  below.

A patient with calcification of the posterior longitudinal ligament of the cervical spine was managed by this technique. The patient's position was supine, and the surgical access was the anterior cervical approach. After successful general anaesthesia, in the first step, the C3-C4, C4-C5, C5-C6, and C6-C7 intervertebral discs were completely resected sequentially (Figure 1A). In the second step, approximately 1/3 of the C4, C5, and C6 vertebral body was resected, and then fusion devices were implanted in the C3-4, C4-5, C5-6, and C6-7 intervertebral spaces (Figure 1B). In the third step, a suitable curved steel plate was placed at the anterior edge of the C3, C7 vertebral body, and then a screw was implanted in each of the C3, C7 veCrteCbral body to fix the plate firmly (Figure 1C). In the fourth step, one screw was implanted in each of the C4, C5, and C6 vertebrae, and then the screws were slowly rotated, so that the C3, C4, and C5 vertebrae, and the posterior longitudinal ligament were slowly brought closer to the plate as a whole, until the vertebral body was completely affixed to the plate (Figure 1D).

Figure 1: (A-D) Steps involved in the technique of anterior fusion of cervical vertebral body complex.

Anterior cervical vertebral body fusion with anterior displacement of the vertebral body ossification complex is a very good new technique, which can avoid damage of the spinal cord, nerves, and blood vessels to a maximum extent, reduce surgical complications, and can be extended to the treatment of thoracic and lumbar spine-related diseases. It is anticipated to undergo further innovation and application in the future.

COMPETING   INTEREST:
The  authors  declared  no  conflict  of  interest.

AUTHORS’   CONTRIBUTION:
WX: Drafted, revised, and edited the manuscript.
XL: Performed data collection, analysis, and interpretation.
CZ: Performed data collection.
All authors approved the final version of the manuscript to be published.

REFERENCES

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