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. Safety measures during PLL opening during microscopic anterior cervical discectomy and risk-free surgery A retrospective clinical case series 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. 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. 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.

中文翻译：

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显微镜下颈椎间盘切除术中后纵韧带切除术：技术和安全考虑

颈椎间盘突出症导致大多数患者后纵韧带（PLL）中断。在ACDF期间，例行打开PLL是完全移除所有磁盘碎片的必要步骤。显微前颈椎间盘切除术和无风险手术期间PLL打开期间的安全措施回顾性临床病例系列该研究针对145例患者进行。主要症状是神经根疼痛。术前通过MRI鉴定PLL。所有患者均接受ACDF手术。我们开始对韧带完整的患者进行中线解剖，而我们利用破裂部位对韧带中断的患者开始并完成解剖。每月进行随访。百分之九十七的患者接受了单层手术。最常用的水平是C5-6。PLL在60.7％的患者中中断。术后即刻，早期和晚期，VAS中位数之间存在统计学差异。46％的患者出现出血。盐水冲洗是止血的合适方法。常规MRI是术前识别PLL的选择方式。最好使用韧带中断的部位开始完整的韧带解剖并开始从中线外侧开始。锋利的解剖最好用弯刀。较薄的脚踏板Kerrison适用于切除其余部分。与双极凝血相比，使用盐水冲洗的止血效果更好且无风险。术后即刻，早期和晚期，VAS中位数之间存在统计学差异。46％的患者出现出血。盐水冲洗是止血的合适方法。常规MRI是术前识别PLL的选择方式。最好使用韧带中断的部位开始完整的韧带解剖并开始从中线外侧开始。锋利的解剖最好用弯刀。较薄的脚踏板Kerrison适用于切除其余部分。与双极凝血相比，使用盐水冲洗的止血效果更好且无风险。术后即刻，早期和晚期，VAS中位数之间存在统计学差异。46％的患者出现出血。盐水冲洗是止血的合适方法。常规MRI是术前识别PLL的选择方式。最好使用韧带中断的部位开始完整的韧带解剖并开始从中线外侧开始。锋利的解剖最好用弯刀。较薄的脚踏板Kerrison适用于切除其余部分。与双极凝血相比，使用盐水冲洗的止血效果更好且无风险。常规MRI是术前识别PLL的选择方式。最好使用韧带中断的部位开始完整的韧带解剖并开始从中线外侧开始。锋利的解剖最好用弯刀。较薄的脚踏板Kerrison适用于切除其余部分。与双极凝血相比，使用盐水冲洗的止血效果更好且无风险。常规MRI是术前识别PLL的选择方式。最好使用韧带中断的部位开始完整的韧带解剖并开始从中线外侧开始。锋利的解剖最好用弯刀。较薄的脚踏板Kerrison适用于切除其余部分。与双极凝血相比，使用盐水冲洗的止血效果更好且无风险。