A novel anterior decompression technique (vertebral body sliding osteotomy) for ossification of posterior longitudinal ligament of the cervical spine

Publication date: Available online 26 February 2018
Source:The Spine Journal
Author(s): Dong-Ho Lee, Jae Hwan Cho, Choon Sung Lee, Chang Ju Hwang, Sung Hoon Choi, Chul Gie Hong
Background ContextConventional anterior decompression surgery for cervical myelopathy, including anterior corpectomy and fusion, is technically demanding and known to be associated with a higher incidence of surgery-related complications, including cerebrospinal fluid (CSF) leakage, neurologic deterioration, and graft failure compared with posterior surgery.PurposeWe introduce a novel anterior decompression technique (vertebral body sliding osteotomy; VBSO) for cervical myelopathy caused by ossification of posterior longitudinal ligament (OPLL) and evaluate the efficacy and safety of this procedure.Study DesignThis is a case series for novel surgical technique.Patient SampleFourteen patients (M:F=11:3, mean age 56.9±10) with cervical myelopathy caused by OPLL who underwent VBSO by a single surgeon were included.Outcome MeasuresThe surgical outcome was evaluated according to the Japanese Orthopaedic Association score for cervical myelopathy (C-JOA score), and the recovery rate of the C-JOA score. Patients were also evaluated radiographically with plain and dynamic cervical spine radiographs and pre- and postoperative CT images.MethodsFourteen patients were followed for more than 24 months and operation time, estimated blood loss (EBL), neurologic outcomes, and surgery-related complications were investigated. Radiological measurements were also performed to analyze following parameters: (1) canal occupying ratio and postoperative canal widening, (2) Pre- and postoperative sagittal alignment.ResultsThe mean recovery rate of C-JOA score at the final follow-up was 68.65 ± 17.8%. There were no perioperative complications, including neurologic deterioration, vertebral artery injury, esophageal injury, graft dislodgement, and CSF leaks, after surgery except for pseudarthrosis in 1 case. An average spinal canal compromised ratio by OPLL decreased from 61.5 ± 8.1% preoperatively to 16.5 ± 11.2% postoperatively. An average postoperative canal widening was 5.15 ± 1.39 mm, and improvement of cervical alignment was observed in all patients with average recovery angle of 7.3 ± 6.1° postoperatively.ConclusionsThe VBSO allows sufficient decompression of spinal cord and provides excellent neurologic outcomes. Because surgeons do not need to manipulate the OPLL mass directly, this technique could significantly decrease surgery-related complications. Furthermore, as it is based on the multi-level discectomy and fusion technique, it would be more helpful to restore a physiologic lordosis.



http://ift.tt/2sZGnQf