Suture Anchor-Assisted Vertebral Body Sliding Osteotomy for Cervical Myelopathy: Surgical Technique, Quantitative Analysis, and Clinical Outcomes.

OBJECTIVE

Traditional Vertebral Body Sliding Osteotomy is technically demanding with variable precision. This study evaluates the surgical precision, clinical efficacy, and learning curve of the novel Suture Anchor-Assisted Vertebral Body Sliding Osteotomy (SA-VBSO) for complex cervical myelopathy.

METHODS

Seventeen consecutive patients (21 osteotomy vertebrae) underwent SA-VBSO. A suture anchor was used for anchor-mediated sliding control, replacing traditional bulky clamps. Precision was quantified using the Adjacent Posterior Vertebral Line method to compare planned versus actual sliding. Decompression was assessed via magnetic resonance imaging cross-sectional area (CSA) and compression ratios. The learning curve was analyzed using chronological procedural times for osteotomies and cage insertions.

RESULTS

All procedures were successful without systematic bias; mean absolute sliding error was 0 ± 1 mm (P = 0.68) and Sliding Accuracy Index was 102 ± 13% (P = 0.54). Radiographic analysis confirmed robust decompression: mean spinal cord cross-sectional area increased from 50 ± 12 to 62 ± 12 mm2 (P < 0.001), and compression ratio improved from 24 ± 6 to 43 ± 8% (P < 0.001). Sagittal alignment improved significantly (C2-C7 Cobb's angle: 3°-9°, P = 0.032). Mean modified Japanese Orthopaedic Association scores rose from 11 ± 1 to 16 ± 1 (P < 0.001). Learning curve analysis demonstrated rapid procedural acceleration, reaching a steady efficiency plateau after 10 to 12 osteotomy segments.

CONCLUSIONS

SA-VBSO is a feasible, precise, and potentially reproducible refinement of traditional Vertebral Body Sliding Osteotomy. By establishing anchor-mediated sliding control, it resolves the "sliding control dilemma" and features a manageable learning curve, offering a reliable technical alternative for complex anterior cervical reconstruction.