Cervical Spondylotic Myelopathy with Ossification of Posterior Longitudinal Ligament: Which Is the Most Suitable Surgical Procedure? A Technical Note

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are widely performed to resolve anterior cervical spine compression. The main purpose of the different surgical techniques is to obtain an adequate decompression of the spinal cord and nerve roots, preserving spinal stability like in oblique corpectomy or leading to a final solid construct to achieve arthrodesis. TECHNICAL NOTE: We describe a surgical procedure for treating cervical spondylotic myelopathy(CSM) with ossification of the posterior longitudinal ligament (OPLL) at the level of C3-C4 and C4-C5. A double level discectomy C3-C4 and C4-C5 and selective posterior wedge corpectomy of C3, C4, and C5 were performed. Two cages (Zero-P VA) at C3-C4 and C4-C5 were positioned to obtain segmental stability and arthrodesis. An extended anterior cervical canal decompression was obtained and confirmed by postsurgical CT scan. At 15 months, dynamic X-ray showed fusion, and cervical magnetic resonance imaging (MRI) showed evidence of spinal canal decompression. CONCLUSIONS: Anterior cervical discectomy followed by selective wedge corpectomy appears to be a safe and effective technique for anterior spinal cord compression extending above and below the intervertebral disc space.