Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Myelopathy: Complications and Pitfalls

Abstract

Objective: This retrospective cohort study has been aimed at evaluating the incidence of complications after vertebral body sliding osteotomy (VBSO) and analyzing some cases. Furthermore, the complications of VBSO were compared with those of anterior cervical corpectomy and fusion (ACCF).

Methods: This study included 154 patients who underwent VBSO (n = 109) or ACCF (n = 45) for cervical myelopathy and were followed up for > 2 years. Surgical complications, clinical and radiological outcomes were analyzed.

Results: The most common surgical complications after VBSO were dysphagia (n = 8, 7.3%) and significant subsidence (n = 6, 5.5%). There were 5 cases of C5 palsy (4.6%), followed by dysphonia (n = 4, 3.7%), implant failure (n = 3, 2.8%), pseudoarthrosis (n = 3, 2.8%), dural tears (n = 2, 1.8%), and reoperation (n = 2, 1.8%). C5 palsy and dysphagia did not require additional treatment and spontaneously resolved. The rates of reoperation (VBSO, 1.8%; ACCF, 11.1%; p = 0.02) and subsidence (VBSO, 5.5%; ACCF, 40%; p < 0.01) were significantly lower in VBSO than in ACCF. VBSO restored more C2-7 lordosis (VBSO, 13.9° ± 7.5°; ACCF, 10.1° ± 8.0°; p = 0.02) and segmental lordosis (VBSO, 15.7° ± 7.1°; ACCF, 6.6° ± 10.2°; p < 0.01) than ACCF. The clinical outcomes did not significantly differ between both groups.

Conclusion: VBSO has advantages over ACCF in terms of low rate of surgical complications related to reoperation and significant subsidence. However, dural tears may still occur despite the lessened need for ossified posterior longitudinal ligament lesion manipulation in VBSO; hence, caution is warranted.

Keywords: Cervical vertebrae; Complications; Ossification of posterior longitudinal ligament; Osteotomy; Spondylosis.

Fig. 1.

Patient selection process. VBSO, vertebral body sliding osteotomy; ACCF, anterior cervical corpectomy and fusion.

Fig. 2.

Representative case of dural tear during vertebral body sliding osteotomy. (A–C) A preoperative radiograph and computed tomography (CT) images. (D, E) Postoperative images with anteriorly translated C4 and C5. (F) CT images after posterior longitudinal ligament resection at C5-6-disc space. During resection, a dural tear occurred.

Fig. 3.

PLL resection procedure in vertebral body sliding osteotomy. (A) OPLL compressing the spinal cord. Pink section indicates PLL. (B) For the translating affected vertebral body, PLL cutting was required. However, as seen in the circle, the dural tear could occur during PLL resection. OPLL, ossified posterior longitudinal ligament; PLL, posterior longitudinal ligament.

Fig. 4.

Representative case of implant failure after C4–5 vertebral body sliding osteotomy. Preoperative (A) and postoperative day 2 (B) radiographs without implant failure. (C) Pull-out of the inserted screw was first observed at 1-month postoperative follow-up. (D) Final. The pulled-out screw did not show any change with a solid fusion state.