Lee Dong-Ho, Cho Sung Tan, Park Sehan, Hwang Chang Ju, Cho Jae Hwan, Kim Jin Hwan
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea.
Neurospine. 2023 Jun;20(2):669-677. doi: 10.14245/ns.2346320.160. Epub 2023 Jun 30.
This retrospective cohort study has been aimed at evaluating the incidence of complications after vertebral body sliding osteotomy (VBSO) and analyzing some cases. Furthermore, the complications of VBSO were compared with those of anterior cervical corpectomy and fusion (ACCF).
This study included 154 patients who underwent VBSO (n = 109) or ACCF (n = 45) for cervical myelopathy and were followed up for > 2 years. Surgical complications, clinical and radiological outcomes were analyzed.
The most common surgical complications after VBSO were dysphagia (n = 8, 7.3%) and significant subsidence (n = 6, 5.5%). There were 5 cases of C5 palsy (4.6%), followed by dysphonia (n = 4, 3.7%), implant failure (n = 3, 2.8%), pseudoarthrosis (n = 3, 2.8%), dural tears (n = 2, 1.8%), and reoperation (n = 2, 1.8%). C5 palsy and dysphagia did not require additional treatment and spontaneously resolved. The rates of reoperation (VBSO, 1.8%; ACCF, 11.1%; p = 0.02) and subsidence (VBSO, 5.5%; ACCF, 40%; p < 0.01) were significantly lower in VBSO than in ACCF. VBSO restored more C2-7 lordosis (VBSO, 13.9° ± 7.5°; ACCF, 10.1° ± 8.0°; p = 0.02) and segmental lordosis (VBSO, 15.7° ± 7.1°; ACCF, 6.6° ± 10.2°; p < 0.01) than ACCF. The clinical outcomes did not significantly differ between both groups.
VBSO has advantages over ACCF in terms of low rate of surgical complications related to reoperation and significant subsidence. However, dural tears may still occur despite the lessened need for ossified posterior longitudinal ligament lesion manipulation in VBSO; hence, caution is warranted.
本回顾性队列研究旨在评估椎体滑动截骨术（VBSO）后并发症的发生率并分析部分病例。此外，将VBSO的并发症与颈椎前路椎体次全切除融合术（ACCF）的并发症进行比较。
本研究纳入了154例因颈椎脊髓病接受VBSO（n = 109）或ACCF（n = 45）治疗且随访时间超过2年的患者。分析手术并发症、临床及影像学结果。
VBSO后最常见的手术并发症为吞咽困难（n = 8，7.3%）和明显下沉（n = 6，5.5%）。有5例发生C5麻痹（4.6%），其次为发音困难（n = 4，3.7%）、植入物失败（n = 3，2.8%）、假关节形成（n = 3，2.8%）、硬脊膜撕裂（n = 2，1.8%）和再次手术（n = 2，1.8%）。C5麻痹和吞咽困难无需额外治疗即可自行缓解。VBSO的再次手术率（VBSO，1.8%；ACCF，11.1%；p = 0.02）和下沉率（VBSO，5.5%；ACCF，40%；p < 0.01）显著低于ACCF。VBSO比ACCF恢复了更多的C2 - 7前凸（VBSO，13.9°±7.5°；ACCF，10.1°±8.0°；p = 0.02）和节段性前凸（VBSO，15.7°±7.1°；ACCF，6.6°±10.2°；p < 0.01）。两组的临床结果无显著差异。
VBSO在与再次手术和明显下沉相关的手术并发症发生率方面优于ACCF。然而，尽管VBSO减少了对后纵韧带骨化病变的处理需求，但仍可能发生硬脊膜撕裂；因此，需谨慎操作。
