Cervical vertebral cortexplasty for anterior controllable antidisplacement and fusion

This video vignette presents a simple and effective method---Cervical Vertebral Cortexplasty (CVC) for bone cement augmentation in Vertebrae-Ossification Complex (VOC) during Anterior Controllable Antedisplacement and Fusion (ACAF) procedures. ACAF have been effectively designed in treating the cervical ossification of the posterior longitudinal ligament (OPLL). The procedure includes both anterior and bilateral osteotomies based on the width and thickness of the OPLL, followed by forward traction of the VOC using rotation of screws on a plate to decompress the spinal canal. However, resection of the anterior cortical bone of the cervical vertebral body in severe osteoporotic patient would obvious reduces screws anchorage ability, which leads to screw loosening and failure of surgery. A 68-year-old female patient with OPLL and severe osteoporosis successfully underwent ACAF surgery, during which CVC facilitated rapid VOC bone cement augmentation by a simple device. After the resection of the anterior cortical bone of the cervical vertebral body, a 50 ml syringe needle was inserted 5 mm deep into the central region of VOC under direct visualization. Then, a 1 ml syringe barrel with bioactive calcium phosphate cement was connected with the 50 ml syringe needle to inject the cement into VOC. CVC effectively simulated to restore the mechanical strength of the cervical cortical bone for the subsequent operation involved palate and screws. The approximately 0.2 ml of cement was injected into the superficial central layer of VOC without leakage. Screws anchorage on it was obviously enhanced, and VOC antedisplacement was successfully performed by one-time. CVC with bioactive cement enhanced screw holding power in short term while preserving bone fusion capacity in mid-to-long term. This video demonstrates the feasibility and advantages of CVC for bone cement augmentation of VOC in ACAF under osteoporotic condition by the low-cost and convenient instruments.