Removal of Retro-Corporeal Compressive Pathology Using Guttering Osteotomy During Anterior Cervical Discectomy and Fusion

Study Design: A retrospective cohort study. Objective: Guttering is a technique that creates a tunnel through the vertebral body adjacent to the endplate to remove compressive pathologies behind the vertebral body during anterior cervical discectomy and fusion (ACDF). In this study, we investigated cases of patients who underwent gutter-shaped osteotomy (guttering) to decompress retro-corporeal compressive lesions. Summary of Background Data: Retro-corporeal pathologies causing cord compression cannot be removed using conventional ACDF. Materials and Methods: A total of 217 patients who underwent ACDF to treat cervical myelopathy and were followed up for ≥1 year were retrospectively reviewed. The fusion rate, subsidence, neck pain visual analog scale (VAS), arm pain VAS, and neck disability index (NDI) were assessed. Results were compared between the guttering (patients for whom guttering was performed) and nonguttering (patients for whom guttering was not performed) groups. Results: Thirty-five patients (16.1%) were included in the guttering group, while 182 patients (83.8%) were included in the nonguttering group. Fusion rates assessed by interspinous motion ( P =0.559) and bone bridging on computed tomography (CT) ( P =0.541 and 0.715, respectively) were not significantly different between the 2 groups at 1 year after surgery. Furthermore, neck pain VAS ( P =0.492), arm pain VAS ( P =0.099), and NDI ( P =1.000) 1 year after surgery did not demonstrate significant intergroup differences. All patients in the guttering group exhibited healed guttering on 1-year postsurgery CT. Conclusions: Guttering as an adjunct to ACDF could provide a more expansive workspace for complete decompression when compressive pathology extends retrocorporeal. This additional bone resection is not associated with increased pseudarthrosis or subsidence or related to aggravation of patient symptoms. Level of Evidence: Level III.