Strategic Use of Single-Level Vertebral Body Sliding Osteotomy Within a 360-Degree Fusion Construct for the Cervical Ossified Posterior Longitudinal Ligament.

Cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) presents significant surgical challenges, especially in multilevel disease with kyphosis or high canal-occupying ratios. While anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are commonly used, both carry notable risks, particularly in patients with poor bone quality. Vertebral body sliding osteotomy (VBSO) is a novel technique that enables anterior decompression by translating the vertebral body without resection, thereby minimizing dural manipulation and graft-related complications. We present the case of a 48-year-old woman with C4-C7 segmental OPLL, kyphosis, and ventral compression, who underwent staged surgery consisting of ACDF with C5 VBSO followed by posterior decompression and C2-T2 fusion. The patient experienced significant neurological improvement, and imaging confirmed successful decompression and alignment restoration. This case highlights the utility of VBSO in complex cervical pathology and supports its role as a safe and effective alternative to ACCF in appropriately selected patients.