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01-10-2019 | Original Article

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

Authors: Qing-Jie Kong, Xiao-Fei Sun, Yuan Wang, Jing-Chuan Sun, Pei-Dong Sun, Hong-di Lv, Zi-qin Wang, Xi-Ming Xu, Yong-Fei Guo, Jian-Gang Shi

Published in: European Spine Journal | Issue 10/2019

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.

Graphic abstract

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Title: Risk assessment of vertebral artery injury in anterior controllable antedisplacement and fusion (ACAF) surgery: a cadaveric and radiologic study
Authors: Qing-Jie Kong
Xiao-Fei Sun
Yuan Wang
Jing-Chuan Sun
Pei-Dong Sun
Hong-di Lv
Zi-qin Wang
Xi-Ming Xu
Yong-Fei Guo
Jian-Gang Shi
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 10/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-06111-0

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Graphic abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Graphic abstract

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