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Cervical instability combined with spinal cord compression remains one of the most challenging conditions in spinal surgery, particularly when complicated by congenital abnormalities and ossification of the posterior longitudinal ligament (OPLL). Achieving sufficient decompression while maintaining cervical stability requires careful balance between surgical effectiveness and safety.
A recent case report published in Orthopaedic Medicine describes the successful application of anterior controllable antedisplacement and fusion (ACAF) in a patient with cervical instability caused by craniocervical malformation and OPLL. The study, led by first author Xi Luo and corresponding author Jingchuan Sun from Changzheng Hospital, highlights the potential of ACAF as an alternative approach for managing complex cervical disorders.
Treating a Rare and Complex Cervical Condition
The reported patient was a 70-year-old man who presented with progressive numbness of the trunk and upper limbs, worsening gait instability, and neurological impairment. Imaging examinations revealed a rare combination of atlantooccipital fusion, absence of the odontoid process, cervical instability, cervical disc herniation, and OPLL-induced spinal cord compression.
Preoperative imaging demonstrated significant displacement between cervical segments, with severe spinal cord compression caused by anterior pathological structures. These complex anatomical abnormalities made conventional surgical strategies difficult, as treatment needed to address both decompression and restoration of cervical stability.
ACAF: Combining Direct Decompression with Improved Safety
Unlike traditional approaches that may require extensive removal of ossified lesions or rely on indirect decompression, ACAF works by isolating and anteriorly displacing the vertebra–ossification complex to enlarge the spinal canal and relieve neural compression.
In this case, the patient underwent C2–4 anterior discectomy and fusion, followed by anterior osteotomy and controlled antedisplacement of the affected vertebral complex. The procedure successfully increased spinal canal volume while maintaining fixation stability.
Postoperative MRI confirmed complete cervical cord decompression. The patient’s Japanese Orthopaedic Association score improved from 6 before surgery to 10 three days after surgery, with neurological symptoms significantly alleviated. No neurological deterioration or major postoperative complications were observed.
Addressing the Limitations of Conventional Approaches
Traditional posterior decompression procedures can provide indirect spinal cord decompression through posterior shifting of the spinal cord, but may be less effective when anterior compression from disc herniation or OPLL is prominent. Meanwhile, anterior corpectomy and fusion can achieve direct decompression but may carry higher risks of complications in complex multilevel OPLL cases.
The authors suggest that ACAF provides a balance between these approaches by achieving direct decompression without requiring complete removal of the ossified lesion. By preserving structural integrity and improving cervical stability, ACAF may reduce risks associated with traditional anterior procedures.
A Promising Option for Future Cervical Surgery
The authors conclude that ACAF combines the decompression advantages of anterior surgery with safety features associated with posterior indirect decompression. With favorable biomechanical properties, complete decompression potential, and a relatively low complication risk, ACAF may represent a valuable treatment option for patients with OPLL accompanied by cervical instability. However, further studies are needed to establish its long-term effectiveness and broader clinical applications.
Publication Details
Journal: Orthopaedic Medicine
Article Title: Anterior controllable antedisplacement and fusion for the treatment of cervical instability caused by craniocervical malformation with ossification of the posterior longitudinal ligament: Case report and literature review
Article Type: Case Report
DOI: 10.61189/383248ahfwao
Publication Date: July 2026
First Author: Xi Luo
Corresponding Author: Jingchuan Sun
Affiliation: Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
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