P16. Controllable vertebral body sliding osteotomy (CVBSO) - a novel modified method for precise measurement and control of anterior sliding of the vertebral body during VBSO in cervical spine surgery

Abstract

BACKGROUND CONTEXT

Degenerative cervical myelopathy (DCM) is a prevalent and challenging condition caused by spinal cord compression from ossification of the posterior longitudinal ligament (OPLL) or cervical kyphotic deformities. Vertebral Body Sliding Osteotomy (VBSO) has emerged as an effective surgical technique, avoiding complete removal of ossified lesions and reducing risks such as dura rupture and cerebrospinal fluid (CSF) leakage. However, traditional VBSO often suffers from a lack of precision in controlling the anterior sliding distance (ASD), potentially leading to over-resection, structural instability, or inadequate decompression. These limitations emphasize the need for a more precise and reproducible approach to optimize outcomes.

PURPOSE

This study introduces Controllable Vertebral Body Sliding Osteotomy (CVBSO), a novel surgical modification designed to overcome the limitations of traditional VBSO by integrating preoperative imaging-guided planning and intraoperative precision.

STUDY DESIGN/SETTING

This report introduces and describes the development of CVBSO as a novel surgical technique, focusing on its implementation in patients with degenerative cervical myelopathy (DCM). The technique was applied and refined in a tertiary spine surgery center, emphasizing its feasibility, precision, and reproducibility.

PATIENT SAMPLE

N/A

OUTCOME MEASURES

N/A

METHODS

CVBSO incorporates the Estimated Anterior Sliding Distance (EASD), calculated preoperatively using sagittal CT or MRI. For OPLL, the EASD is defined as the anterior-posterior diameter of the ossified lesion, while in other conditions, it is measured as the vertical distance between a reference line and the compression site. The procedure employs the Smith-Robinson approach, involving discectomy, bilateral longitudinal osteotomy, and real-time measurement of ASD to ensure alignment with the preplanned EASD. Guided cage placement and plate fixation are used to stabilize the construct.

RESULTS

The CVBSO technique achieved precise control of ASD, preventing over- or under-decompression and reducing risks such as over-resection or structural instability. This approach simplified surgical steps, minimized surgeon-dependent variability, and improved decompression outcomes. Patients undergoing CVBSO demonstrated enhanced neurological recovery and optimized postoperative recovery compared to traditional VBSO techniques.

CONCLUSIONS

CVBSO represents a significant advancement in cervical spine surgery, addressing critical limitations of traditional VBSO. By ensuring precise spinal cord decompression and simplifying the surgical process, CVBSO minimizes complications and enhances clinical outcomes. Future studies in larger cohorts and multi-center settings are warranted to validate its efficacy and explore the integration of advanced technologies such as navigation and robotics to further improve precision and safety.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.