Principles of the Technique
- VBSO is a novel anterior surgical approach for decompressing the spinal cord in patients with Degenerative Cervical Myelopathy (DCM)
- The fundamental principle is to expand the spinal canal by physically translating the vertebral body anteriorly, thereby decompressing the spinal cord.
- This technique reduces the need for direct removal of the compressing pathology, such as ossified masses or bony spurs, from the dura.
- A key goal of VBSO is to achieve adequate decompression while also restoring cervical lordosis and improving sagittal alignment
- The procedure can change a patient's status from K-line negative to K-line positive by restoring the lordotic curve, which facilitates posterior drift of the spinal cord.
Indications
- Degenerative cervical myelopathy (DCM)
- Alternative to corpectomy for DCM
- It is particularly recommended for patients with a high canal space-occupying ratio and a K-line negative status.
- involving three or fewer levels
- OPLL
- It is an effective option in cases where there is dural adhesion, which would make a corpectomy high-risk.
- Cervical deformity
- For patients with rigid kyphosis involving more than three levels, VBSO can be a valuable technique to reduce the number of surgical stages while minimising complications.
Surgical technique
- (A) Two parallel longitudinal slits are made along the medial borders of the uncinated process.
- (B) Anterior translation of vertebral body is done by Allis forceps.
- (C) Cervical interbody cages are inserted with Caspar retractor distracted.
- Multiple lordotic interbody cages are inserted into the space created by the translation, which helps to dramatically restore cervical lordosis.
- (D) Cervical column is temporarily stabilizaed by releasing the traction force made by a Caspar retractor.
- (E) The protruding protions of the anteriorly translated bodies are shaved down using a high-speed burr or Leksell rongeurs.
- (F) Anteiror plating is done with plate and screw
Surgical Outcome
- Reduced Complications:
- VBSO is associated with fewer complications than corpectomy, notably a lower risk of dural tears, cerebrospinal fluid (CSF) leakage, pseudarthrosis (non-union), and subsidence. This is largely because it avoids the direct detachment of pathology from the dura
- Effective Decompression:
- The technique provides adequate decompression of the spinal cord
- Improved Fusion and Stability:
- VBSO has shown a higher fusion rate and faster union than ACDF
- The stability from multiple fixation points contributes to a markedly lower subsidence rate compared to the long-strut grafts used in corpectomy
- Reduced Surgical Burden:
- In complex cases of rigid kyphosis that might otherwise require a three-stage circumferential (Posterior-Anterior-Posterior) surgery, VBSO can reduce the procedure to a single session.
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