Intraoperative O-arm navigation guided anterior cervical corpectomy and fusion with minimally invasive cervical pedicle screw fixation (MICEPS) for severe ossification of the cervical posterior longitudinal ligament (OPLL): A technical note

• Main Authors: Yoshihiro Fujiwara, Ying Tan, Venkatesh Kadiri, Koji Uotani, Taro Yamauchi, Masato Tanaka
• Format: Article
• Language: English
• Published: Elsevier 2021-03-01
• Series: Interdisciplinary Neurosurgery
• Subjects: Anterior cervical corpectomy and fusion; Ossification of the posterior longitudinal ligament; Navigation; C-arm free
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751920304631

Background: Anterior cervical corpectomy and fusion (ACCF) with floating technique is one of the best surgical interventions for severe ossification of the posterior longitudinal ligament (OPLL). However, insufficient decompression and a thinned ossification mass often lead to poor clinical outcome. This report describes a novel floating technique with intraoperative O-arm navigation to facilitate surgical treatment of the OPLL, which has not previously been described as a therapeutic option. Case description: An 82-year-old woman with myelopathy of the OPLL was referred to our hospital. Activities of daily living had been restricted by severe left arm pain, myelopathy hand, and gait disturbance for 3 years. ACCF was performed under the guidance of O-arm navigation and C-arm-free minimally invasive cervical pedicle screw fixation (MICEPS). The patient was successfully treated surgically and manual muscle test results and sensory function of the left arm had recovered fully by final follow-up at 1 year. Japanese Orthopedic Association score of the patient had improved from 10/17 to 16/17. Conclusions: Intraoperative O-arm navigation-guided ACCF with C-arm-free MICEPS is an effective technique for achieving precise decompression and strong, minimally invasive fixation. This new anterior navigation technique provides an excellent result for severe OPLL without the risk of adverse events from intraoperative radiation.