Indirect Posterior Decompression With a Plate Gliding Technique During an Anterior Cervical Discectomy and Fusion for Treatment of Cervical Myelopathy Accompanied by Ligamentum Flavum Pathologies: A Technical Note and Case Series.

Abstract

Technical note and case series. We describe an indirect posterior decompression technique using plate gliding during anterior cervical discectomy and fusion (ACDF) in cervical myelopathy patients with an accompanying posterior pathology. ACDF can effectively address an anterior pathology, that is, directly causing cord compression. However, a concurrent posterior pathology, such as hypertrophy or buckling of the ligamentum flavum, is challenging to resolve. Furthermore, occasional worsening of cord compression after ACDF due to aggravation via a posterior pathology may occur. We reviewed 6 patients with cervical myelopathy who underwent the plate gliding technique during ACDF in 2023. We assessed radiologic factors, including cord compression from the ligamentum flavum (CCLF) grade and segmental lordosis, before and after surgery. In addition, we evaluated the Japanese Orthopedic Association (JOA) scores preoperatively and 3 months postoperatively. A postoperative improvement in CCLF grade was observed in all patients alongside a decrease in segmental lordosis. The average recovery rate indicated by the JOA scores at 3 months postoperatively was 65.3%. An indirect decompression technique using plate gliding during ACDF is beneficial for cervical myelopathy patients accompanied by posterior pathologies such as ligamentum flavum hypertrophy or buckling.