Technical ReportA novel anterior decompression technique (vertebral body sliding osteotomy) for ossification of posterior longitudinal ligament of the cervical spine
Introduction
Ossification of the posterior longitudinal ligament (OPLL) results from pathologic replacement of the posterior longitudinal ligament with lamellar bone, potentially causing spinal cord compression and neurologic deterioration. Surgical decompression via an anterior or posterior approach is the treatment of choice for myelopathic patients with severe compression observed on computed tomography (CT) or magnetic resonance imaging (MRI) [1], [2].
Although anterior decompression, such as cervical corpectomy, is an excellent option along with direct removal of the OPLL mass, when more than two or three cervical levels are affected, posterior surgery, such as laminoplasty or laminectomy with or without fusion, is preferred because of the technical ease and lower rate of complications. However, in patients with a high occupying ratio of OPLL, hill-shaped ossification, or kyphotic alignment, posterior decompression will not achieve an adequate posterior shift of the spinal cord, and sufficient neurologic improvement cannot be expected [3].
In contrast, conventional anterior decompression surgery, such as anterior corpectomy and fusion, is technically demanding and is associated with a higher incidence of surgery-related complications, including dysphagia, cerebrospinal fluid (CSF) leakage, implant dislodgement, or pseudarthrosis of the grafting bone, compared with posterior surgery [4], [5], [6], [7].
Dural tear is also more common with anterior surgery, which can be dangerous for both surgeons and patients. Particularly when the dura mater is ossified or severely adheres to the posterior longitudinal ligament, complete removal of the ossified lesion may lead to dural tear and subsequent CSF leakage.
To prevent these complications and achieve effective anterior decompression, we developed a novel anterior decompression technique, called vertebral body sliding osteotomy (VBSO). Its basic concept is to expand the spinal canal by anteriorly translating the involved vertebral bodies and any ossified masses. The aims of the present study were (1) to reveal the technical plausibility of this technique and (2) to evaluate the efficacy and safety of this procedure.
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Materials and methods
The present study was a case series to evaluate our new surgical technique for treatment of cervical myelopathy caused by segmental-type OPLL. Fourteen patients (11 men, 3 women) with cervical myelopathy caused by OPLL who underwent VBSO between January 2012 and December 2014 at our institution were included. As a surgical indication, myelopathic patients with more than moderate gait impairment underwent surgical treatment. Ossification of posterior longitudinal ligament lesions with a high
Results
Clinical data and surgical outcomes of the 14 patients who underwent VBSO are listed in the Table. There were 12 men and 2 women, with a mean age of 56.9±10 years. All patients were followed up for more than 24 months, with an average follow-up period of 36.6±7.2 months.
The mean C-JOA score improved from 12.4±2.9 preoperatively to 16±1.4 at the final follow-up (p<.01). The mean recovery rate of the C-JOA score at the final follow-up was 68.65±17.8% and no patient showed neurologic deterioration
Discussion
Some studies have reported that anterior surgery for OPLL is more effective for decompression of the spinal canal, allowing direct removal of the ossified mass. Furthermore, cervical corpectomy and fusion is one of the most widely used techniques via an anterior approach for cervical myelopathy caused by OPLL. However, surgical removal of the OPLL mass through an anterior approach is technically demanding and is associated with a higher incidence of perioperative complications compared with
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Cited by (30)
Fusion and subsidence rates of vertebral body sliding osteotomy: Comparison of 3 reconstructive techniques for multilevel cervical myelopathy
2021, Spine JournalCitation Excerpt :Previous studies have demonstrated that VBSO is the best indicated for involvement of 2 or 3 segments that cannot be decompressed by ACDF or posterior procedures because of location of pathologic foci, kyphotic alignment, and significant neck pain [4,11–14]. Although VBSO has been reported to achieve sufficient spinal cord decompression and restoration of lordosis, its application, even for indicated cases, would be limited if it is associated with a high rate of non-union or subsidence [11–14]. The results of the present study demonstrated that VBSO had a higher 1-year fusion rate at 92.9% than ACDF and ACCF.
How much space of the spinal canal should be restored by hoisting the vertebrae–OPLL complex for sufficient decompression in anterior controllable antedisplacement and fusion? A multicenter clinical radiological study
2021, Spine JournalCitation Excerpt :Because the locations of the spinal cord and nerve roots can return to their precompressed positions, a lower incidence of C5 palsy has been observed with ACAF [25,27]. Coincidentally, Lee et al. also reported a novel anterior decompression technique termed vertebral body sliding osteotomy that is based on the same surgical principle as ACAF [28]. They found that vertebral body sliding osteotomy provides similar neurologic outcomes and a lower incidence of such complications as pseudarthrosis and graft migration, compared with ACCF [29].
Pseudarthrosis after the bulk floating procedure
2024, Journal of Neurosurgery: Spine
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Author disclosures: DHL: Nothing to disclose. JHC: Nothing to disclose. CSL: Nothing to disclose. CJH: Nothing to disclose. SHC: Nothing to disclose. CGH: Nothing to disclose.