Cervical corpectomy and plate fixation for postlaminectomy kyphosis

Abstract

Between 1987 and 1991, 20 patients with symptomatic postlaminectomy kyphosis were treated with anterior decompression, bone graft, and anterior cervical plate. The patients were predominantly male (14:6) with a mean age of 58 years. The initial laminectomy was performed for either spondylosis (80%) or spinal tumor (20%). All patients had anterior compressive pathology, which was associated with instability (45%), neck pain (75%), myeloradiculopathy (90%), or severe neck deformity (30%). The mean degree of kyphosis was 38 degrees. Treatment consisted of a trial of cervical traction (75%), anterior corpectomy (95%), intersegmental decompression (5%), bone fusion (100%), and fixation with either Caspar (85%) or Synthes (15%) anterior plating at a mean of 3.8 levels. Halo fixation was used in 10% of patients. Postoperative complications included vocal cord paresis (15%), pneumonia (10%), wound dehiscence (5%), and screw pull-out (5%). At follow-up evaluation, a mean of 28 months after treatment, all patients had a solid fusion and a mean curvature improvement to 16 degrees residual kyphosis. Neurologically, 10% were cured, 55% were improved and returned to premorbid function, 30% were stable, and 5% had late progression. These data suggest that immediate fixation with anterior plating facilitates solid fusion, maintains spinal curvature, and promotes neurological improvement.

A late neurological complication following posterior correction surgery of severe cervical kyphosis

“…As to correction angles of kyphotic deformity in the cervical spine treated by anterior procedures, Ferch et al [27] reported the preoperative kyphosis was 10°and correction was 11°on average. Herman et al [13] reported that their kyphosis correction was 21°on average. Both studies did not report any postoperative late neurological complications.…”

“…For kyphosis correction of the cervical spine, some surgeons select the anterior procedure [13,14], whereas other surgeons choose the posterior [15,16] or a combination of anterior and posterior approaches [17,18]. In posterior cervical reconstruction surgery, postoperative neurological deficits unrelated to instrument malpositioning or hematoma formation have been reported by some authors [8,[19][20][21] Heller et al [8] reported 2 (2.7%) cases with this complication after posterior cervical reconstruction surgery using lateral mass screws and plates.…”

“…It permits decompression of anterior pathology as well as kyphosis correction with strut grafting [26]. There were some studies of anterior correction of cervical kyphosis via a single anterior approach, after which no postoperative neurological deficit occured [13,26,27]. With the anterior procedure, it is easy to apply a distraction force between vertebral bodies, which provides segmental widening of the disc space to create cervical lordosis.…”

Anterior Cervical Corpectomy and Fusion Accelerates Degenerative Disease at Adjacent Vertebral Segments

“…Indications include degenerative disorders, [1][2][3] neoplasms, 4-5 trauma, [6][7] infectious disorders, 8 or correction of either degenerative or iatrogenic kyphosis. [9][10][11][12] The procedure has enjoyed excellent clinical results, in terms of neurological outcomes, and success of arthrodesis and stabilization. 2,9,[13][14][15][16] Fusion of the cervical spine has biomechanical consequences.…”

“…[9][10][11][12] The procedure has enjoyed excellent clinical results, in terms of neurological outcomes, and success of arthrodesis and stabilization. 2,9,[13][14][15][16] Fusion of the cervical spine has biomechanical consequences. Loss of mobility at one functional spinal unit increases the load sustained by the remaining units.…”