Complications following central corpectomy in 468 consecutive patients with degenerative cervical spine disease

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>This study was performed to describe the incidence and predictors of perioperative complications following central corpectomy (CC) in 468 consecutive patients with cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL).</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors performed a retrospective review of a cohort of patients who had undergone surgery for CSM (n = 338) or OPLL (n = 130) performed by a single surgeon over a 15-year period. All patients underwent uninstrumented CC with autologous iliac crest or fibular strut grafting. Preoperative clinical and imaging details were collected, and the type and incidence of complications were studied. Univariate and multivariate analyses were performed to establish risk factors for the development of perioperative complications.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Overall, 12.4% of patients suffered at least 1 complication following CC. The incidence of major complications was as follows: C-5 radiculopathy, 1.3%; recurrent laryngeal nerve injury, 0.4%; dysphagia, 0.8%; surgical-site infection, 3.4%; and dural tear, 4.3%. There was 1 postoperative death (0.2%). On multivariate analysis, patients in whom the corpectomy involved the C-4 vertebral body (alone or as part of multilevel CC) were significantly more likely to suffer complications (p = 0.004). OPLL and skip corpectomy were risk factors for dural tear (p = 0.015 and p = 0.001, respectively). No factors were found to be significantly associated with postoperative C-5 palsy, dysphagia, or acute graft extrusion on univariate or multivariate analysis. Patients who underwent multilevel CC were predisposed to surgical-site infections, with a slight trend toward statistical significance (p = 0.094). The occurrence of a complication after surgery significantly increased the mean duration of postoperative hospital stay from 5.0 ± 2.3 days to 8.9 ± 6 days (p &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Complications following CC for CSM or OPLL are infrequent, but they significantly prolong hospital stay. The most frequent complication following CC is dural tear, for which a diagnosis of OPLL and a skip corpectomy are significant risk factors.</jats:p></jats:sec>

Successful management of cervical tuberculosis and severe kyphosis using polyetheretherketone expandable cage and titanium plate: A case report

“…Multiple reconstructive procedures have been advocated following cervical corpectomy, including the use of autologous bone grafts from the iliac and fibular bones. Several studies have associated iliac crest bone graft (ICBG) use with complications such as donor site morbidity, pseudoarthrosis, and potential graft dislodgement 4 . Despite these issues, polyetheretherketone (PEEK) cages have been shown to be an effective treatment option for cervical spondylosis, even in infectious cases.…”

Modified ACDF Technique for the Treatment of Centrum Focal Ossification of the Posterior Longitudinal Ligament: A Case Report

“…Intraoperative C5 nerve root injury is an aspect of iatrogenic nerve injury, with an incidence of 1.6%–12%. 32 Centrum grooving wounds >15 mm may lead to a higher risk of C5 nerve injury. We think that this may be due to disruption of the venous network in the centrum affecting the effective perfusion of nerves.…”

“…This situation mainly stems from anterior soft tissue and centrum small blood vessel injury; however, it can be eliminated with adequate drainage and absorption. Intraoperative C5 nerve root injury is an aspect of iatrogenic nerve injury, with an incidence of 1.6%–12% 32 . Centrum grooving wounds >15 mm may lead to a higher risk of C5 nerve injury.…”

Radiological determination of safe and adequate corpectomy limits in the cervical region

“…The reoperation rate was reported to be 0.1% due to insufficient decompression and inability of placing the graft properly. Good planning of the distance for corpectomy will allow adequate decompression and a proper decompression area to allow the graft to be placed properly (22). This will further reduce graft-related reoperation rates.…”