{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T10:17:52Z","timestamp":1773829072819,"version":"3.50.1"},"reference-count":15,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 (\u2212) OPLL or a canal occupying a ratio of \u226550%, 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 \u226550% underwent exLAPPS for cervical OPLL. The mean operative time was 248 min (range, 165\u2013342 min) and the mean blood loss was 320 mL (range, 50\u2013740 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.<\/jats:p>","DOI":"10.3390\/jcm15062307","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T07:35:08Z","timestamp":1773819308000},"page":"2307","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3390","volume":"15","author":[{"given":"Kentaro","family":"Yamane","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1, Tamasu, Kita-ku, Okayama 701-1192, Okayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6485-4806","authenticated-orcid":false,"given":"Wataru","family":"Narita","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kameoka Municipal Hospital, 1-1, Shinonoda, Shino-cho, Kameoka 621-8585, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichiro","family":"Takao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1, Tamasu, Kita-ku, Okayama 701-1192, Okayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hisakazu","family":"Shitozawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1, Tamasu, Kita-ku, Okayama 701-1192, Okayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhiro","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1, Tamasu, Kita-ku, Okayama 701-1192, Okayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinnosuke","family":"Nakahara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1, Tamasu, Kita-ku, Okayama 701-1192, Okayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1097\/BRS.0b013e318188b300","article-title":"A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: The K-line","volume":"33","author":"Fujiyoshi","year":"2008","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1302\/0301-620X.105B4.BJJ-2022-0804.R2","article-title":"Comparison of the outcome after anterior cervical ossified posterior longitudinal ligament en bloc resection versus posterior total laminectomy and fusion in patients with ossification of the cervical posterior longitudinal ligament: A prospective randomized controlled trial","volume":"105","author":"Cao","year":"2023","journal-title":"Bone Jt. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1007\/s00586-016-4555-8","article-title":"Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (\u2212) cervical ossification of the posterior longitudinal ligament","volume":"25","author":"Koda","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.spinee.2016.07.532","article-title":"Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a \u226550% canal occupying ratio: A multicenter retrospective study","volume":"16","author":"Yoshii","year":"2016","journal-title":"Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Yamane, K., Narita, W., Takao, S., and Takeuchi, K. (2024). Exoscopic minimally invasive open-door laminoplasty for cervical myelopathy: A technical note and preliminary analysis of clinical outcomes during the acute postoperative period. J. Clin. Med., 13.","DOI":"10.3390\/jcm13082173"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1093\/ons\/opy277","article-title":"Preliminary clinical microneurosurgical experience with the 4K3-dimensional microvideoscope (ORBEYE) system for microneurological surgery: Observation study","volume":"16","author":"Murai","year":"2019","journal-title":"Oper. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.clineuro.2018.09.010","article-title":"Pros and cons of using ORBEYE\u2122 for microneurosurgery","volume":"174","author":"Takahashi","year":"2018","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1097\/BSD.0000000000000421","article-title":"Minimally invasive cervical pedicle screw fixation by a posterolateral approach for acute cervical injury","volume":"30","author":"Komatsubara","year":"2017","journal-title":"Clin. Spine Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/BSD.0000000000000832","article-title":"Minimally invasive cervical pedicle screw fixation (MICEPS) via a posterolateral approach","volume":"32","author":"Tokioka","year":"2019","journal-title":"Clin. Spine Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2800","DOI":"10.1097\/01.brs.0000192297.07709.5d","article-title":"The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae","volume":"30","author":"Neo","year":"2005","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1097\/00007632-199705010-00009","article-title":"Cervical pedicle screws versus lateral mass screws: Anatomic feasibility and biomechanical comparison","volume":"22","author":"Jones","year":"1997","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/BRS.0b013e318239cc7e","article-title":"New techniques for exposure of posterior cervical spine through intermuscular planes and their surgical application","volume":"37","author":"Shiraishi","year":"2012","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1097\/BRS.0b013e3181d34614","article-title":"Preservation of muscles attached to the C2 and C7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty","volume":"35","author":"Sakaura","year":"2010","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"450","DOI":"10.3171\/SPI.2008.9.11.450","article-title":"Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion","volume":"9","author":"Ito","year":"2008","journal-title":"J. Neurosurg. Spine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"614","DOI":"10.3390\/tomography7040052","article-title":"Cervical Spine Pedicle Screw Accuracy in Fluoroscopic, Navigated and Template Guided Systems-A Systematic Review","volume":"7","author":"Mahmoud","year":"2021","journal-title":"Tomography"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2307\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T07:58:06Z","timestamp":1773820686000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":15,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062307"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062307","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]}}}