Anterior zero-profile V-osteotomy: A safe and effective approach for segmental and localized-type cervical OPLL

Anterior cervical subtotal vertebral decompression and fusion (ACCF) provides an extensive decompression space, and the orthopedic surgeon needs to remove a large number of endplates and vertebrae to achieve sufficient decompression. In contrast, V-shaped vertebral osteotomy performed via the intervertebral space achieves effective decompression through resection of the entire pathological posterior wall tissue while allowing for better preservation of the vertebral endplates. This study therefore aims to evaluate the efficacy and safety of the surgical approach utilizing the zero-profile interbody fusion system with interbody V-shaped osteotomy.

This retrospective study included 135 patients with ossification of the posterior longitudinal ligament (OPLL) who underwent anterior cervical decompression and fusion, with a minimum follow-up of 12 months. We evaluated Patient characteristics, fusion rates, subsidence, and patient-reported outcome measures, including the neck pain visual analog scale (VAS) score, arm pain VAS score, and the Japanese Orthopaedic Association (JOA) score. A comparison was made between patients who underwent ACCF (ACCF group) and those who underwent surgery with the zero-profile interbody fusion system combined with interbody V-shaped osteotomy (ZPVO group).

A total of fifty-five patients (40.7 %) were included in the ZPVO group and eighty patients (59.3 %) in the ACCF group. In the ZPVO group, 40.2 % ± 7.3 % of the endplate was resected, and 38.2 % ± 6.5 % of the region behind the vertebral body could be visualized via the ZPVO technique; the resection angle measured was 36.7° ± 9.2°. There was no significant difference between the two groups in terms of either the fusion rates or the subsidence rates (p > 0.05). Additionally, the two groups demonstrated comparable clinical outcomes without significant differences at the 1-year follow-up. Notably, the ZPVO group demonstrated a significantly lower incidence of early postoperative dysphagia, along with reduced intraoperative blood loss, compared to the ACCF group.

The ZPVO technique achieved adequate decompression while preserving partial endplates and provided access to 38.2 % of the region posterior to the vertebral body. Furthermore, it demonstrated comparable fusion rates without increasing subsidence rates, indicating uncompromised biomechanical stability. Most notably, this approach allows for the removal of pathologic tissue from the posterior vertebral wall through a single-level discectomy, thereby obviating the need for corpectomy. Based on these findings, we propose the ZPVO technique as a viable and strategic alternative to ACCF for the management of cervical spondylotic myelopathy caused by posterior vertebral wall pathologies.