Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament

Abstract

Study Design: Retrospective cohort study. Objectives: Vertebral body sliding osteotomy (VBSO) has previously been reported as a technique to decompress ossification of the posterior longitudinal ligament (OPLL) by translating the vertebral body anteriorly. This study aimed to evaluate the radiological and clinical efficacies of VBSO and clarify the surgical indications of VBSO for treating myelopathy caused by OPLL. Methods: Ninety-seven patients with symptomatic OPLL-induced cervical myelopathy treated with VBSO or laminoplasty who were followed up for more than 2 years were retrospectively reviewed. Cervical alignment, range of motion, fusion, modified K-line (mK-line) status, and minimum interval between ossified mass and mK-line (INT(min)), and the Japanese Orthopaedic Association (JOA) score were assessed. Patients in the VBSO group were compared with those who underwent laminoplasty. Results: Cervical lordosis and INT(min) significantly increased in the VBSO group. All patients in the VBSO group assessed as mK-line (-) preoperatively were assessed as mK-line (+) postoperatively. However, in the LMP group, the mK-line status changed from (+) preoperatively to (−) postoperatively in 3 patients. Final JOA score (p = 0.02) and JOA score improvement (p = 0.01) were significantly higher in the VBSO group. JOA recovery ratio (p = 0.03) and proportion of patients with a recovery rate ≥50% were significantly higher in the VBSO group (p < 0.01). Conclusions: VBSO is an effective surgical option for OPLL-induced myelopathy, demonstrating favorable neurological recovery and lordosis restoration with low complication rates. It is best indicated for kyphotic alignment, OPLL with a high space-occupying ratio, and OPLL involving ≤3 segments.

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

“…Although bone spurs and OPLL mass are not directly resected in VBSO but translated anteriorly, clinical outcomes were comparable to those of ACDF and ACCF. Therefore, the advantages of anterior decompression do not necessarily require direct removal of compressive lesions and can be achieved by canal widening through indirect decompression via anterior translation 14,15,17…”

“…Previous studies have also demonstrated better lordosis restoration and faster bone union with VBSO than with corpectomy 16–18. Despite these favorable results, the longevity of VBSO has not been shown, as previous studies have been relegated to only short-term follow-up 14,17,19. Whether these favorable effects could be maintained over long-term surveillance or whether VBSO could result in unexpected complications, remains unclear.…”

“…VBSO is an anterior decompression and fusion technique involving anterior vertebral body translation. 14,15 VBSO results in fewer complications, including dural tears or graft dislodgement, as it minimizes the direct manipulation of ossified masses and provides multiple fixation points within the construct, similar to ACDF. Previous studies have also demonstrated better lordosis restoration and faster bone union with VBSO than with corpectomy.…”

“…To address the limitations of ACDF and ACCF, vertebral body sliding osteotomy (VBSO) has been introduced. VBSO is an anterior decompression and fusion technique involving anterior vertebral body translation 14,15. VBSO results in fewer complications, including dural tears or graft dislodgement, as it minimizes the direct manipulation of ossified masses and provides multiple fixation points within the construct, similar to ACDF.…”

What Type of Incision for Anterior Cervical Spine Surgery Involving Long Segments Can Bring Better Cosmetic and Functional Outcomes?

“…VBSO is a surgical technique reported as a substitute for corpectomy [ 10 ]. In VBSO, the vertebral body is translated anteriorly to widen the spinal canal, minimizing the need for direct removal of the pathology such as ossified mass and bony spurs [ 11 - 13 ]. For double transverse incision, 2 transverse incisions were made parallel to Langer’s skin line, with the bridge of the minimum 3-cm flap secured between the 2 incisions ( Fig.…”