Vertebral body sliding osteotomy looks better than corpectomy, from four cohorts and one surgeon

Design

Systematic review and meta-analysis of four retrospective cohorts, GRADE assessed

Population

449 patients with cervical myelopathy or ossified posterior longitudinal ligament (209 osteotomy, 240 corpectomy), all from one Korean centre

Primary outcome

Neurological recovery, complications and radiographic parameters

Effect

Osteotomy: subsidence RR 0.23, pseudarthrosis RR 0.25, revision RR 0.17, neurological deterioration RR 0.17; JOA favoured corpectomy by 0.59 points (95% CI 0.22 to 0.96); very low certainty throughout

Vertebral body sliding osteotomy translates the vertebral body forward to enlarge the canal without dissecting ossified posterior longitudinal ligament off the dura, which is the step that makes anterior cervical corpectomy and fusion hazardous. A systematic search to June 2025 found four retrospective cohorts, 449 patients, 209 osteotomies against 240 corpectomies.

On the numbers the osteotomy wins on almost everything mechanical: graft subsidence RR 0.23, pseudarthrosis RR 0.25, revision surgery RR 0.17, neurological deterioration RR 0.17, all P at or below 0.02, with greater postoperative lordosis and shorter stay. Corpectomy had marginally higher postoperative JOA scores (MD -0.59, 95 per cent CI -0.96 to -0.22) of doubtful clinical meaning. Cerebrospinal fluid leak favoured the osteotomy but not significantly.

The authors then dismantle their own result, and they are right to. All four studies came from one institution, Asan Medical Center in Seoul, with overlapping enrolment between 2006 and 2020 - so patients may be counted more than once - and the same first author appears on every one, who is the technique's developer. Leave-one-out analysis showed the JOA, neurological deterioration and pseudarthrosis results were driven by a single large study. GRADE certainty was very low for every outcome. Treat this as a well-argued case that the technique deserves an independent multicentre trial, not as a reason to change what you offer a patient with myelopathy next week.

• Read the certainty rating before the relative risks; very low GRADE across all outcomes is the headline here.
• Note that overlapping enrolment periods from one centre may mean the same patients appear in several studies.
• Developer-series results in surgical technique reliably shrink when independent teams reproduce them.
• Keep corpectomy as the standard for complex myelopathy and ossified posterior longitudinal ligament for now.
• If you are considering adopting the osteotomy, do it in a registry or trial, not ad hoc.

The statistics, in plain English

Relative risks of 0.17 to 0.25 look decisive, but a leave-one-out sensitivity analysis that flips or dissolves several of them means the pooled estimate is standing on one study rather than four. GRADE certainty of very low is a formal statement that the true effect is likely to be substantially different from the estimate. The JOA difference of 0.59 points is statistically significant and clinically negligible - a useful reminder that those are separate questions.

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