Der Orthopäde

, Volume 48, Issue 2, pp 170–174 | Cite as

Anterior cervical corpectomy and fusion

Spinal cord compression caused by buckled ligamentum flavum
  • Lei He
  • Y. QianEmail author


Anterior cervical corpectomy and fusion (ACCF) is a commonly performed surgical procedure for cervical spondylotic myelopathy (CSM). Various complications associated with ACCF have been reported; however, spinal cord compression caused by buckling of the ligamentum flavum (LF) after ACCF has not yet been well recognized. This article describes the case of a 59-year-old man who underwent ACCF at C5 for treatment of CSM. Although numbness and weakness of the upper extremities were relieved 2 weeks after the operation, gait imbalance persisted and worsened at 7 months. Magnetic resonance imaging (MRI) performed at 12 months revealed buckling of the LF into the spinal canal at the C5/6 level, compressing the spinal cord; moreover, high signal intensity in the spinal cord was observed beneath the buckling area on T2-weighted images. The secondary laminoplasty at C5 and C6 was performed 13 months after primary surgery and MRI showed that the spinal canal was widened at the C5 and C6 levels and the spinal cord was decompressed.


Complication Surgery Decompression Cervical vertebrae Cervical spondylotic myelopathy 



Anterior cervical corpectomy and fusion


Cervical spondylotic myopathy


Japanese Orthopaedic Association


Ligamentum flavum


Magnetic resonance imaging




Sagittal vertical axis

Anteriore zervikale Korpektomie und Fusion

Myelonkompression durch Vorwölbung des Lig. flavum


Die anteriore zervikale Korpektomie und Fusion ist eine bei zervikaler spondylotischer Myelopathie (CSM) häufig durchgeführte Operation. Verschiedene mit dieser Intervention assoziierte Komplikationen sind dokumentiert, eine nach ACCF auftretende Rückenmarkkompression durch Vorwölbung des Lig. flavum (LF) ist vielfach allerdings noch nicht bekannt. Der Artikel stellt einen 59-jährigen Patienten vor, der wegen einer CSM mit einer ACCF auf Höhe von C5 behandelt wurde. Zwei Wochen postoperativ hatten sich Taubheit und Schwäche in den oberen Extremitäten gebessert, doch die Gangstörung war zunächst unverändert geblieben und hatte sich 7 Monate postoperativ sogar verschlechtert. In der Magnetresonanztomographie (MRT) 12 Monate nach dem Eingriff zeigte sich eine Vorwölbung des LF, auf den T2-gewichteten Aufnahmen stellten sich sogar Hochintensitätsbereiche innerhalb des Rückenmarks unter dem Bereich der Vorwölbung dar. Dreizehn Monate nach dem Primäreingriff wurde eine sekundäre Laminoplastik auf Höhe C5/C6 durchgeführt. In der MRT zeigten sich danach eine entsprechende Aufweitung des Spinalkanals und eine Dekompression des Myelons.


Komplikation Operative Intervention Dekompression Zervikale Wirbelkörper Zervikale spondylotische Myelopathie 


Compliance with ethical guidelines

Conflict of interest

H. Lei and Y. Qian declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. For images or other information within the manuscript which identify patients, consent was obtained from them and/or their legal guardians.


  1. 1.
    Xiao SW, Jiang H, Yang LJ, Xiao ZM (2015) Anterior cervical discectomy versus corpectomy for multilevel cervical spondylotic myelopathy: a meta-analysis. Eur Spine J 24(1):31–39. CrossRefPubMedGoogle Scholar
  2. 2.
    Liu Y, Hou Y, Yang L, Chen H, Wang X, Wu X, Gao R, Wang C, Yuan W (2012) Comparison of 3 reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy. Spine 37(23):E1450–E1458. CrossRefPubMedGoogle Scholar
  3. 3.
    Matz PG, Pritchard PR, Hadley MN (2007) Anterior cervical approach for the treatment of cervical myelopathy. Neurosurgery 60(Supp1):S64–S70. PubMedGoogle Scholar
  4. 4.
    Feng F, Ruan W, Liu Z, Li Y, Cai L (2016) Anterior versus posterior approach for the treatment of cervical compressive myelopathy due to ossification of the posterior longitudinal ligament: a systematic review and meta-analysis. Int J Surg 27:26–33. CrossRefPubMedGoogle Scholar
  5. 5.
    Bernhardt M, Hynes RA, Blume HW, White AA 3rd (1993) Cervical spondylotic myelopathy. J Bone Joint Surg Am 75(1):119–128CrossRefPubMedGoogle Scholar
  6. 6.
    Harrison DD, Janik TJ, Troyanovich SJ, Holland B (1996) Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine 21(6):667–675CrossRefPubMedGoogle Scholar
  7. 7.
    Suda K, Abumi K, Ito M, Shono Y, Kaneda K, Fujiya M (2003) Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine 28(12):1258–1262. PubMedGoogle Scholar
  8. 8.
    Secer HI, Harman F, Aytar MH, Kahraman S (2017) Open-door laminoplasty with preservation of muscle attachments of C2 and C7 for cervical spondylotic myelopathy, Retrospective Study. Turk Neurosurg. Google Scholar
  9. 9.
    Wang ZL, Xiao JL, Mou JH, Qin TZ, Liu P (2015) Analysis of cervical sagittal balance parameters in MRIs of patients with disc-degenerative disease. Med Sci Monit 21:3083–3088. CrossRefPubMedGoogle Scholar
  10. 10.
    Grob D, Frauenfelder H, Mannion AF (2007) The association between cervical spine curvature and neck pain. Eur Spine J 16(5):669–678. CrossRefPubMedGoogle Scholar
  11. 11.
    Hardacker JW, Shuford RF, Capicotto PN, Pryor PW (1997) Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine 22(13):1472–1480 (discussion 1480)CrossRefPubMedGoogle Scholar
  12. 12.
    Harrison DD, Harrison DE, Janik TJ, Cailliet R, Ferrantelli JR, Haas JW, Holland B (2004) Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine 29(22):2485–2492CrossRefPubMedGoogle Scholar
  13. 13.
    Nojiri K, Matsumoto M, Chiba K, Maruiwa H, Nakamura M, Nishizawa T, Toyama Y (2003) Relationship between alignment of upper and lower cervical spine in asymptomatic individuals. J Neurosurg 99(1 Suppl):80–83PubMedGoogle Scholar
  14. 14.
    Gillis CC, Kaszuba MC, Traynelis VC (2016) Cervical radiographic parameters in 1‑ and 2‑level anterior cervical discectomy and fusion. J Neurosurg Spine 25:421–429. CrossRefPubMedGoogle Scholar
  15. 15.
    Park JH et al (2013) T1 slope and cervical sagittal alignment on cervical CT radiographs of asymptomatic persons. J Korean Neurosurg Soc 53:356–359. CrossRefPubMedGoogle Scholar
  16. 16.
    Okuda T, Fujimoto Y, Tanaka N, Ishida O, Baba I, Ochi M (2005) Morphological changes of the ligamentum flavum as a cause of nerve root compression. Eur Spine J 14(3):277–286. CrossRefPubMedGoogle Scholar
  17. 17.
    Safak AA, Is M, Sevinc O, Barut C, Eryoruk N, Erdogmus B, Dosoglu M (2010) The thickness of the ligamentum flavum in relation to age and gender. Clin Anat 23(1):79–83. PubMedGoogle Scholar
  18. 18.
    Park JB, Chang H, Lee JK (2001) Quantitative analysis of transforming growth factor-beta 1 in ligamentum flavum of lumbar spinal stenosis and disc herniation. Spine 26(21):E492–495CrossRefPubMedGoogle Scholar
  19. 19.
    Beamer YB, Garner JT, Shelden CH (1973) Hypertrophied ligamentum flavum. Clinical and surgical significance. Arch Surg 106(3):289–292CrossRefPubMedGoogle Scholar
  20. 20.
    Kosaka H, Sairyo K, Biyani A, Leaman D, Yeasting R, Higashino K, Sakai T, Katoh S, Sano T, Goel VK, Yasui N (2007) Pathomechanism of loss of elasticity and hypertrophy of lumbar ligamentum flavum in elderly patients with lumbar spinal canal stenosis. Spine 32(25):2805–2811. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OrthopaedicsShaoxing People’s HospitalShaoxingChina

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