Posterior longitudinal ligament resection during microscopic anterior cervical discectomy: technique and safety consideration

Abstract Background Herniation of the cervical disk material results in interruption of the posterior longitudinal ligament (PLL) in the majority of patients. Routine opening of the PLL during ACDF is a necessary step for complete removal of all disk fragments. Objectives Safety measures during PLL opening during microscopic anterior cervical discectomy and risk-free surgery Study design A retrospective clinical case series Patients and methods The study was conducted on 145 patients. The main symptom was radicular pain. Pre-operative identification of PLL was assessed by MRI. All patients were operated upon by ACDF. We started dissection off the midline in patients with intact ligament while we used the site of disruption to start and complete dissection in patients with interrupted ligament. Follow-up was done monthly. Results Ninety-seven percent of patients underwent single level surgery. The most commonly operated level was C5-6. PLL was interrupted in 60.7% of patients. There was a statistically significant difference between median VAS in immediate, early, and late post-operative period. Bleeding was encountered in 46% of patients. Saline irrigation was a suitable method for hemostasis. Conclusion Conventional MRI is the modality of choice for pre-operative identification of PLL. It is better to use the site of ligament interruption to start sharp dissection and to start lateral to the midline in intact ligament. Sharp dissection is better with curved knife. Thin foot plate Kerrison is suitable for excision of the remaining parts. Hemostasis using saline irrigation is better and non-risky than using bipolar coagulation.