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Risk assessment of vertebral artery injury in anterior controllable antedisplacement and fusion (ACAF) surgery: a cadaveric and radiologic study

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Abstract

Purpose

We have introduced a novel surgery technique named anterior controllable antedisplacement and fusion (ACAF) for the treatment of ossification of the posterior longitudinal ligament. As reported, the satisfactory postoperative outcome can be attributed to the larger decompression width. However, it may associate with high prevalence of vertebral artery injury (VAI) theoretically. Thus, assessment of the vulnerability of vertebral artery in ACAF is of great importance.

Methods

Computed tomographic scan data of 28 patients were retrospectively studied. Seven radiographic parameters were evaluated: uncinate process (UP) tips distance, transverse foramen (TF)-UP tips distance, TF-LWL (the ipsilateral limited wedging line) distance, the limited distance of lateral decompression, the maximum oblique angle of LWL, TF-LWG (the lateral wall of groove) distance, and width of groove. Eleven fresh cadaveric spines undergoing ACAF surgery were also studied. Two anatomic parameters were evaluated: width of groove and LWG-TF distance.

Results

The UP tips distance increased from C3 to C6 and tended to be larger in males. The UP tip-TF distance and LWL-TF distance were smallest at C4, but both were larger than 2 mm. Maximum oblique angle decreased from C3 to C6. Postoperatively, both radiographic and cadaveric measurements showed the width of groove was larger than UP tips distance, but LWG-TF distance was larger than 2 mm in all levels.

Conclusion

UP can be used as anatomical landmarks to avoid VAI during ACAF surgery. Radiographic and cadaveric measurements verified the safety of ACAF surgery, even for those cases with wedging and lateral slotting.

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Funding

This study was supported by a grant from the National Natural Science Foundation of China (No. 81650031).

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Author notes

  1. Qing-Jie Kong and Xiao-Fei Sun have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People’s Republic of China

    Qing-Jie Kong, Xiao-Fei Sun, Yuan Wang, Jing-Chuan Sun, Xi-Ming Xu, Yong-Fei Guo & Jian-Gang Shi

  2. Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, Southern Medical University, No. 1023 Shatai Road, Baiyun District, Guangzhou, 510515, People’s Republic of China

    Pei-Dong Sun

  3. The 990th Hospital of People’s Liberation Army, No. 1 Fenghuang Road, Zhumadian, 463000, Henan Province, People’s Republic of China

    Hong-di Lv

  4. Henan Provincial Corps Hospital of Chinese People’s Armed Police Forces, No. 1 Kangfu Zhong Street, Zhengzhou, 450000, Henan Province, People’s Republic of China

    Zi-qin Wang

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  1. Qing-Jie Kong
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  2. Xiao-Fei Sun
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  3. Yuan Wang
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Correspondence to Yuan Wang or Jian-Gang Shi.

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Kong, QJ., Sun, XF., Wang, Y. et al. Risk assessment of vertebral artery injury in anterior controllable antedisplacement and fusion (ACAF) surgery: a cadaveric and radiologic study. Eur Spine J 28, 2417–2424 (2019). https://doi.org/10.1007/s00586-019-06111-0

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  • DOI: https://doi.org/10.1007/s00586-019-06111-0

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