Safety and Efficacy of a Novel Anterior Decompression Technique for Ossification of Posterior Longitudinal Ligament of the Cervical Spine

Abstract

Introduction: Anterior cervical corpectomy and fusion (ACCF) for cervical ossification of the posterior longitudinal ligament (OPLL) is associated with a high incidence of surgery-related complications. A novel anterior decompression technique (vertebral body sliding osteotomy [VBSO]) has been developed to prevent such complications. This study attests the efficacy and safety of VBSO versus those of standard ACCF. Methods: Patients requiring surgery for cervical OPLL underwent VBSO (24 patients) or ACCF (38 patients). Operating time, estimated blood loss, neurologic outcomes, complications, and various radiographic parameters were investigated. Results: The VBSO group showed a shorter mean operating time and less estimated blood loss versus the ACCF group. Sixteen patients in the ACCF group experienced various complications, namely neurologic deficit (two patients), cerebrospinal fluid leakage (four patients), graft migration (three patients), and pseudarthrosis (seven patients). In the VBSO group, only pseudarthrosis was reported (two patients). Conclusions: VBSO provides similar neurologic outcomes with a shorter operating time and less bleeding compared with ACCF. Surgeons do not need to directly manipulate the OPLL mass or dissect the interspace between the OPLL and dura mater. Therefore, this technique may decrease the incidence of surgery-related complications. Study Design: Retrospective comparative study.

Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis

“…29 After accumulating enough cases, we presented several articles that demonstrated the objective safety and efficacy of the technique. [10][11][12][13] Meanwhile, a similar technique was introduced in Asia, but we believe the originality of this technique belongs to us.…”

“…In VBSO, the vertebral body is translated anteriorly to widen the spinal canal, minimizing the need for direct manipulation of the interspace between the PLL and dura mater, or complete removal of the involved vertebral bodies. 13 It shows fewer complications, as it minimizes the direct separation of the PLL from the dura. Thus, it can notably reduce the risk of dural tears.…”

“…VBSO showed better outcomes than ACCF in terms of canal widening and improvements of myelopathic symptoms. 13 Therefore, the VBSO technique is an effective and safe option for anterior decompression surgery in patients with cervical myelopathy. In addition to its safety and efficiency of proper decompression and fusion, VBSO can be a powerful method to restore cervical lordosis.…”

“…[6][7][8][9] Hence, we previously reported a novel anterior decompression technique called vertebral body sliding osteotomy (VBSO). [10][11][12][13] VBSO allows for expansion of the spinal canal by anteriorly translating the vertebral body without complete removal. Our previous studies demonstrated that VBSO can decrease the risks of dural tear and pseudarthrosis while effectively achieving cord decompression.…”

“…Anterior cervical corpectomy and fusion (ACCF) has been widely used for direct decompression as treatment for multilevel myelopathy, but high rates of implant dislodgement due to graft instability and dural tear during resection of the vertebral body have been reported, especially in patients with ossification of the posterior longitudinal ligament (OPLL) [ 6 - 9 ]. Hence, we previously reported a novel anterior decompression technique called vertebral body sliding osteotomy (VBSO) [ 10 - 13 ].…”