Anterior Subtotal Cervical Vertebrae Resection with Bone Grafting and Internal Fixation for Treating Long Segmental Ossification of the Posterior Longitudinal Ligament: Involving Key Players in Orthopedic and Neurosurgical Teams

Abstract

Objective: This case-control study aimed to assess the effectiveness and benefits of anterior subtotal cervical vertebrae resection, bone grafting, and internal fixation in treating long segmental ossification of the posterior longitudinal ligament (OPLL) compared to traditional methods. Methods: Between July 2021 and June 2022, 72 patients diagnosed with multi-segmental cervical vertebra OPLL at our hospital were randomly divided into a control group (n=36), treated with anterior cervical discectomy and fusion (ACDF), and a study group (n=36), treated with anterior subtotal cervical vertebrae resection, bone grafting, and internal fixation. A three-month follow-up was conducted for all patients to evaluate surgical outcomes, pain relief using the Visual Analogue Scale (VAS), and functional recovery using the Japanese Orthopedic Association (JOA) score. Additional assessments included cervical curvature index (CCI), cervical range of motion (ROM), and C2-7 sagittal vertical axis (C2-7SVA) through imaging studies. Vertebral body heights at decompression ends (HAB) and changes in the posterior vertebral edge heights (HPB) were measured. Quality of life improvements and postoperative complication rates were also analyzed. Results: The study group exhibited significantly shorter hospital stays and bone healing times (P<0.05). Three months’ post-surgery, JOA scores improved significantly, and VAS scores decreased markedly, with the study group showing greater improvements in both metrics (P<0.05). Postoperative CCI was reduced, but the study group had a lower CCI loss, indicating better maintenance of cervical curvature (P<0.05). While postoperative ROM decreased, the study group experienced a lesser degree of loss, maintaining higher mobility (P<0.05). C2-7SVA increased postoperatively, with the study group showing a greater increase, suggesting better sagittal balance (P<0.05). Measurements of HAB and HPB three months’ post-operation indicated significant improvements in vertebral body heights in the study group (P<0.05). Quality of life scores (physical, psychological, and social functions) were significantly higher in the study group after three months (P<0.05). However, the incidence of postoperative complications was also higher in the study group (P<0.05). Conclusion: Anterior subtotal cervical vertebrae resection, bone grafting, and internal fixation offer a promising treatment for cervical OPLL, resulting in shorter hospitalization and bone healing times, improved neurological function, and better preservation of cervical curvature compared to ACDF. Despite a higher rate of postoperative complications, the benefits in functional recovery and quality of life make this approach a valuable clinical option.