Evaluating the clinical reliability of ultrasonic osteotome in anterior cervical surgeries for ossification of the posterior longitudinal ligament with comorbid spondylotic myelopathy: A retrospective study

This study investigates the clinical reliability of the ultrasonic osteotome in anterior surgeries and guide treating cervical spondylotic myelopathy (CSM) comorbid with ossification of the posterior longitudinal ligament (OPLL). Direct resection of ossified ligament via anterior surgery is favorable for treating cervical OPLL, but the associated surgical risks make some surgeons hesitant. We retrospectively analyzed patients with CSM and OPLL who underwent anterior cervical discectomy with fusion or anterior cervical corpectomy with fusion from January 2015 to December 2022. Patients were divided into the ultrasonic osteotome group (Group A) and the conventional tools group (Group B). These assessments were conducted before the surgery and at 1 week, 1 month, 3 months, and 6 months during postoperative follow-up. Parameters were compared between the 2 groups, including operation time, intraoperative blood loss, postoperative drainage, length of hospital stay, complications, and clinical outcomes using Japanese Orthopaedic Association (JOA) scores, JOA recovery rate (JOA RR), visual analog scale (VAS), and VAS recovery rate. There were 62 patients with CSM and OPLL. Group A had significantly shorter operation times (110.88 ± 8.45 vs 127.43 ± 15.29 minutes), less intraoperative blood loss (124.57 ± 17.00 vs 164.57 ± 24.31 mL), and lower postoperative drainage volumes (107.22 ± 14.51 vs 113.47 ± 16.51 mL) than Group B ( P < .05). Neurological symptoms improved significantly in all patients after surgery. At the 1-month follow-up, Group A showed a significantly higher JOA RR than Group B (74.15 ± 12.50% vs 78.87 ± 14.64%, P < .05). No significant differences were observed between the groups regarding complication rates, postoperative length of stay, therapeutic efficacy, JOA RR at 1 week, 3 months, and 6 months post-operation, or VAS recovery rate at any follow-up time point ( P > .05). Using an ultrasonic osteotome in anterior surgery for CSM patients with OPLL may be safe and reliable. Anterior surgical resection of ossified masses with the assistance of an ultrasonic osteotome may be an optimal option for patients with short-segment OPLL.