Fusion and subsidence rates of vertebral body sliding osteotomy: Comparison of 3 reconstructive techniques for multilevel cervical myelopathy

Park

et al. 2023

Spine

Self Cite

Study Design. A retrospective cohort study. Objective. To evaluate the outcomes of vertebral body sliding osteotomy (VBSO) with a minimum follow-up of five years and compare the results with those of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF). Summary of Background Data. VBSO reportedly results in fewer complications, better lordosis restoration, and faster bone union than corpectomy. Although previous studies demonstrate the outcomes of VBSO with follow-up of two years or longer, results in longer term surveillance remain unknown. Methods. This study included 128 patients who underwent VBSO (n=38), ACDF (n=62), or ACCF (n=28) as a treatment for cervical myelopathy and was followed up for five years or more. Fusion, subsidence, C0-2 lordosis, C2-7 lordosis, segmental lordosis, C2-7 sagittal vertical axis, surgical complications, and neck pain visual analog scale, Neck Disability Index, and Japanese Orthopedic Association (JOA) scores were assessed. Comparisons between continuous variables in each group were made using independent sample t tests. For nominal variables, the Fisher exact test or the χ2 test was used. Paired t test was used to analyze the changes in postoperative values compared with preoperative values. Results. The reoperation rate (0.0%) after VBSO was significantly lower than that after ACCF (14.3%; P=0.028). VBSO had a higher fusion rate at six-month and one-year follow-up, but the fusion rate at five years (97.4%) was not significantly different from that of ACDF (85.5%; P=0.054) and ACCF (85.7%; P=0.077). Segmental lordosis at the five-year follow-up was significantly higher in the VBSO group (16.1°) than in the ACDF (11.9°; P=0.002) and ACCF (6.5°; P<0.001) groups. C2-7 lordosis at five-year follow-up was significantly higher in the VBSO group than in the ACCF group (P=0.017). Neck pain visual analog scale, Neck Disability Index, and JOA scores and the JOA recovery rate did not show significant intergroup differences during the five-year study period. Conclusions. VBSO showed promising long-term results in terms of low revision rate, fast solid union, and effective segmental lordosis restoration when compared with other anterior reconstruction techniques.

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 89%

mentioning

confidence: 99%

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Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Myelopathy: Outcomes at Minimum Five years Follow-up

Park

et al. 2023

Spine

Self Cite

J Orthop Surg (Hong Kong)

“…ACDF and ACCF are two practical methods that are used for spinal decompression and cervical lordosis reconstruction for the treatment of severe spinal stenosis. 9 However, the subject of alternative surgical modalities is still controversial. Most surgeons prefer ACCF because it is easier to extirpate ossification.…”

Section: Introductionmentioning

confidence: 99%

Comparison of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of localized ossification of the posterior longitudinal ligament

Chen

Wang

Zhou

et al. 2023

Background The retrospective study was conducted to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) for localized ossification of the posterior longitudinal ligament (OPLL) by evaluating clinical and radiologic outcomes. Methods We reviewed 151 patients to assess the effects of treatment for one or two levels localized OPLL. Perioperative parameters, such as blood loss, operation time and complications, were recorded. Radiologic outcomes, such as the occupying ratio (OR), fusion status, cervical lordosis angle, segmental angle, disc space height, T1 slope, and C2–C7 sagittal vertical axis (SVA), were assessed. Clinical indices, such as the JOA scores and VAS scores, were investigated to compare the two surgical options. Results There were no significant differences in the JOA scores or VAS scores between the two groups ( p > 0.05). The operation time, volume of blood loss and incidence of dysphagia were significantly less in the ACDF group than in the ACCF group ( p < 0.05). In addition, cervical lordosis, segmental angle and disc space height were significantly different from their preoperative evaluations. No adjacent segment degenerated in the ACDF group. The subsidence rates of implants were 5.2% in the ACDF group and 28.4% in the ACCF group. The degeneration of the ACCF group was 4.1%. The incidence of CSF leaks was 7.8% in the ACDF group and 13.5% in the ACCF group. All the patients ultimately achieved successful fusion. Conclusion Although both options achieved satisfactory primary clinical and radiographic efficacies, ACDF was associated with a shorter surgical procedure, less intraoperative blood loss, better radiologic outcomes, and lower incidence of dysphagia than ACCF.

“…Anterior surgery allows resection of the ossi ed mass to achieve direct decompression because the primary pathological mechanism of OPLL is spinal cord compression. ACDF and ACCF are two practical methods that are used for spinal decompression and cervical lordosis reconstruction for the treatment of severe spinal stenosis [9]. However, the subject of alternative surgical modalities is still controversial.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Anterior Cervical Discectomy and Fusion and Anterior Cervical Corpectomy and Fusion in Localized Ossification of the Posterior Longitudinal Ligament

Chen

Wang

Zhou

et al. 2022

Preprint

The retrospective study was conducted to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) for localized ossification of the posterior longitudinal ligament (OPLL) by evaluating clinical and radiologic outcomes. We reviewed 151 patients to assess the effects of treatment for localized OPLL. Perioperative parameters, such as blood loss, operation time and complications, were recorded. Radiologic outcomes, such as the occupying ratio (OR), fusion status, cervical lordosis angle, segmental angle, segmental height, T1 slope, and C2–C7 sagittal vertical axis (SVA), were assessed. Clinical indices, such as the JOA scores and VAS scores, were investigated to compare the two surgical options. There were no significant differences in the JOA scores or VAS scores between the two groups (P > 0.05). The operation time, volume of blood loss and incidence of dysphagia were significantly less in the ACDF group than in the ACCF group(P < 0.05). In addition, cervical lordosis, segmental angle and segmental height were significantly different from their preoperative evaluations. Both groups had significantly improved T1 slopes. Moreover, C2–C7 SVA was significantly increased at the last follow-up. No adjacent segment degenerated in the ACDF group. The degeneration of the ACCF group was 4.1%. The incidence of CSF leaks was 7.8% in the ACDF group and 13.5% in the ACCF group. All the patients ultimately achieved successful fusion. Although both options achieved satisfactory primary clinical and radiographic efficacies, ACDF was associated with a shorter surgical procedure, less volume of intraoperative blood loss, better radiologic outcomes and lower incidence of dysphagia than ACCF.