# Exoscopic Minimally Invasive Open-Door Laminoplasty with Pedicle Screw Fixation for Cervical Ossification of the Posterior Longitudinal Ligament: A Technical Note and Preliminary Clinical Experience

## TL;DR

This paper introduces a new minimally invasive surgical technique for treating cervical OPLL, showing promising results in early clinical use.

## Contribution

The novel exoscopic minimally invasive open-door laminoplasty with pedicle screw fixation (exLAPPS) technique is introduced for cervical OPLL treatment.

## Key findings

- ExLAPPS was successfully performed in 7 patients with acceptable operative time and blood loss.
- Postoperative imaging showed adequate spinal cord decompression in all patients.
- Pedicle screw placement had a low deviation rate of 1.9%.

## Abstract

Background: Posterior decompression with instrumented fusion (PDF) is a conventional surgical procedure performed in patients with massive ossification of the posterior longitudinal ligament (OPLL); however, it is invasive to the posterior cervical tissues. In this report, we introduce a novel PDF technique, exoscopic minimally invasive open-door laminoplasty with pedicle screw fixation (exLAPPS), to treat cervical OPLL, while minimizing posterior tissue damage. Methods: ExLAPPS was indicated for patients with K-line (−) OPLL or a canal occupying a ratio of ≥50%, allowing decompression from C3 to C7. A small midline incision was used for the navigation reference placement and exoscopic minimally invasive open-door laminoplasty, whereas bilateral lateral incisions were utilized for posterior fixation, including pedicle screw insertion, based on the minimally invasive cervical pedicle screw technique. Results: A total of 7 patients with K-line (-) or a canal occupancy ≥50% underwent exLAPPS for cervical OPLL. The mean operative time was 248 min (range, 165–342 min) and the mean blood loss was 320 mL (range, 50–740 mL). Postoperative imaging demonstrated adequate spinal cord decompression in all patients. A total of 52 pedicle screws were inserted, with a pedicle screw deviation rate of 1.9%. Conclusions: ExLAPPS is a minimally invasive surgical technique designed for posterior decompression and fixation in patients with cervical OPLL. In this preliminary case series, the procedure was successfully performed with acceptable operative time, blood loss, and screw placement accuracy. Although the present study did not include a direct comparison with conventional procedures, these preliminary observations suggest that ExLAPPS is a feasible surgical option for selected patients with cervical OPLL.