Vertebral body sliding osteotomy as a less invasive alternative to 540° surgery for cervical myelopathy with rigid kyphosis.

PURPOSE: Cervical myelopathy with rigid kyphosis often requires multilevel decompression and realignment. Although 540° surgery-posterior decompression with screw fixation, anterior decompression and fusion, and posterior rod connection-can achieve adequate neural decompression and sagittal correction, it involves substantial surgical burden. This study compared vertebral body sliding osteotomy (VBSO), an anterior-based technique, with 540° surgery for multilevel cervical myelopathy with rigid kyphosis.

METHODS

A retrospective cohort of 57 patients treated between 2015 and 2022 was analyzed, including 38 who underwent VBSO and 19 who underwent 540° surgery. All patients required fusion across three or more levels and had a minimum of two years of follow-up. Selective ACDF was added to VBSO when pathology extended across disc spaces. Clinical outcomes included Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Visual Analog Scale (VAS) for neck pain. Radiological parameters included C2-7 lordosis, segmental lordosis, and canal occupying ratio. Operative time, estimated blood loss (EBL), and complications were also evaluated.

RESULTS

Improvements in JOA, NDI, and neck pain VAS were comparable between groups (all p > 0.05). Postoperative C2-7 lordosis was similarly restored, and complication rates showed no significant differences. VBSO demonstrated a markedly shorter operative time (262.1 vs. 440.4 minutes, p < 0.001) and lower EBL (100.4 vs. 272.2 mL, p < 0.001).

CONCLUSIONS

VBSO achieved clinical and radiological improvement with reduced surgical burden relative to 540° surgery. These findings suggest that VBSO may be considered a reasonable and efficient alternative for treating cervical myelopathy with rigid kyphosis.