Modified Anterior Controllable Antidisplacement and Fusion (ACAF) Technique Treating the Complex Cervical Spine Diseases

<title>Abstract</title> <p>Purpose The anterior controllable antidisplacement and fusion (ACAF) technique offers notable advantages for complex cervical spine diseases such as ossification of the posterior longitudinal ligament (OPLL). However, challenges including imprecise slotting positioning, oblique slotting orientation, and inadequate lifting of the ossified mass may occur. This study designed a slotting guide plate and an auxiliary lifting device to optimize the modified ACAF technique and evaluated its clinical efficacy. Methods A retrospective study was conducted on 22 patients with complex cervical spine diseases treated from July 2021 to May 2025. Twelve patients underwent modified ACAF (Group A) and Ten underwent conventional ACAF (Group B). Preoperative and final follow-up data were compared, including JOA scores, VAS scores, surgical duration, intraoperative blood loss, slotting angles, Gap distance between the mobilized vertebra and the anterior plate (GD-VBP), cervical MRI Kang's grading, and complication rates. Results The mean follow-up was 23.5 ± 13.1 months. No significant differences were found between groups in JOA scores (14.63 ± 1.43 vs. 14.0 ± 1.49, P &gt; 0.05), VAS scores (0.9 ± 0.7 vs. 0.8 ± 0.63, P &gt; 0.05), surgical duration (220 ± 26.5 vs. 233.2 ± 40.0 min, P &gt; 0.05), or blood loss (196.3 ± 103.6 vs. 256.0 ± 90.2 mL, P &gt; 0.05). Group A demonstrated significantly smaller left (2.7 ± 1.8° vs. 6.5 ± 3.9°) and right (3.8 ± 2.1° vs. 9.2 ± 4.6°) slotting angles and GD-VBP (0.46 ± 0.89 vs. 2.38 ± 2.73 mm) than Group B (P &lt; 0.05). No significant difference was observed in Kang's grading (0.3 ± 0.4 vs. 0.5 ± 0.5, P &gt; 0.05). One case of C5 nerve palsy occurred in Group A and one cerebrospinal fluid leakage in Group B. Conclusion Both modified and conventional ACAF demonstrate satisfactory efficacy and high safety. The modified technique provides distinct advantages in ensuring vertical slotting and adequate lifting of the ossified mass, facilitating surgery according to preoperative planning.</p>