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

Abstract

Traditional Vertebral Body Sliding Osteotomy (VBSO) is technically demanding with variable precision. This study evaluates the surgical precision, clinical efficacy, and learning curve of the novel Suture Anchor-Assisted VBSO (SA-VBSO) for complex cervical myelopathy. Seventeen consecutive patients (21 osteotomy vertebrae) underwent SA-VBSO. A suture anchor was utilized for anchor-mediated sliding control, replacing traditional bulky clamps. Precision was quantified using the Adjacent Posterior Vertebral Line (APVL) method to compare planned versus actual sliding. Decompression was assessed via MRI cross-sectional area (CSA) and compression ratios. The learning curve was analyzed using chronological procedural times for osteotomies and cage insertions. 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 CSA 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 (C2-7 Cobb's angle: 3° to 9°, p=0.032). Mean mJOA 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. SA-VBSO is a feasible, precise, and potentially reproducible refinement of traditional VBSO. 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.