Objective
To analyze long-term clinical and radiological outcomes after multilevel anterior osteotomy with posterior instrumentation in patients with ossification of posterior longitudinal ligament (OPLL)-induced myelopathy and cervical kyphosis.
Methods
Patients who underwent multilevel anterior osteotomy with posterior instrumentation for OPLL-induced myelopathy and cervical kyphosis and had a minimum of 5-year follow-up were included. Clinical outcomes (Japanese Orthopaedic Association score system for cervical myelopathy [C-JOA], 12-item Short Form health survey [SF-12], Neck Disability Index [NDI]) and radiological parameters (C2–7 lordosis, center of gravity of the head [CGH]-C7 sagittal vertical axis [SVA], T1 slope) were analyzed at the preoperative, immediate postoperative, and latest follow-up timepoints.
Results
Twenty-eight patients were included. The average follow-up period was 66.4 months. All clinical outcome parameters showed significant improvement. C-JOA, SF-12, and NDI showed significant improvement at latest follow-up (p<0.001). C2–7 lordosis increased significantly immediately postoperatively (-6.0°±10.4°) compared to preoperatively (+9.2°±9.6°), and was largely maintained at latest follow-up (-5.7°±9.4°). T1 slope significantly increased between the immediate postoperative timepoint (21.9°±7.7°) and latest follow-up (24.2°±9.5°) (p=0.046). CGH-C7 SVA significantly increased between the immediate postoperative timepoint (22.7±14.8 mm) and latest follow-up (32.2±22.6 mm) (p=0.046).
Conclusion
Multilevel anterior osteotomy with posterior instrumentation is a safe and effective surgical option for OPLL-induced myelopathy with kyphotic cervical alignment. Future studies are required to investigate the forward tilting of cervical spine over time after surgery.

Objective
Anterior lumbar interbody fusion (ALIF) has advantages over posterior lumbar interbody fusion or transforaminal lumbar interbody fusion techniques in that it minimizes damage to the anatomical structure of the posterior spinal segment and enables indirect decompression of the foramen by insertion of a tall cage. However, the predominant abdominal scar tissue reduces patients’ satisfaction after ALIF. Herein, we describe the technique of transumbilical lumbar interbody fusion (TULIF) and its preliminary results in a case series.
Methods
A retrospective review of 154 consecutive patients who underwent TULIF between the L2–3 and L4–5 levels was performed. After preoperatively selecting patients by evaluating the location of the umbilicus and vessel anatomy, a vertical skin incision was made on the umbilicus to minimize the abdominal scar tissue.
Results
There were 120 single-level (110 L4–5 and 10 L3–4), 31 two-level, and 3 three-level surgeries. All patients were very satisfied with their postoperative abdominal scars, which were noticeably faint compared to those after conventional ALIF.
Conclusion
TULIF is a feasible, minimally invasive surgical option that can achieve both the treatment of degenerative spinal disease and satisfactory cosmesis. Although it is technically demanding, patients obtain sufficient benefits.