Anterior Controllable Antedisplacement and Fusion (ACAF) versus laminoplasty in suppressing the progression of ossification of the posterior longitudinal ligament.

Authors

Shunmin Wang, Yu Chen, Jian Ping Fan, Yongfei Guo, Yuan Wang, Jingchuan Sun, Jiangang Shi, Ximing Xu

Published in

Neurosurgical review. Volume 49. Issue 1. Aug 25, 2026. Epub Aug 25, 2026.

Abstract

Laminoplasty (LP) is a standard motion-preserving procedure for multi-segmental ossification of the posterior longitudinal ligament (OPLL), yet it may permit continued ossification progression due to retained segmental mobility. The anterior controllable antedisplacement and fusion (ACAF) technique offers ventral decompression with segmental stabilization, but its effect on OPLL fate remains unclear. To compare radiographic OPLL progression and neurological outcomes between ACAF and LP in patients with multilevel cervical OPLL. This retrospective study included 100 patients (50 ACAF, 50 LP) treated between 2019 and 2021. Radiographic parameters included OPLL thickness, length, width, cervical range of motion (ROM), and a novel morphological classification (Types 1-4). Neurological status was assessed using the Japanese Orthopaedic Association (JOA) score. Mean follow-up was approximately 34 months. ACAF demonstrated significantly smaller increases in OPLL thickness for Types 1, 2, and 3 lesions (all P < 0.05), with no significant difference in Type 4. ROM was markedly reduced in the ACAF group (7.32° ± 4.21° vs. 31.45° ± 6.23°, P < 0.001) and correlated with OPLL thickness progression (r = 0.612, P = 0.002). Neurological improvement was significantly higher in the ACAF group (70.12% ± 22.47% vs. 57.42% ± 16.32%, P = 0.002). Radiographic regression of OPLL was observed in 28.6% of ACAF patients. Complication profiles were acceptable, with higher dysphagia in ACAF and higher axial neck pain in LP. ACAF was associated with significantly reduced OPLL progression and superior neurological recovery compared to LP, likely through biomechanical stabilization and favorable modulation of the local microenvironment. These findings support ACAF as a promising strategy for both neural decompression and biological containment of OPLL progression.

PMID:
42640539
Bibliographic data and abstract were imported from PubMed on 26 Aug 2026.

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