Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy

Rl, Macdonald; Fehlings, Michael G.; Ch, Tator; Lozano, Andrés M.; Fleming, Peter J.; Gentili, François; Bernstein, Mark; Wallace, Megan Jane; Rr, Tasker

doi:10.3171/jns.1997.86.6.0990

Cited by 256 publications

(128 citation statements)

References 30 publications

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“…Unfortunately, details on the number of instrumented vertebra, distribution of decompressed levels, and additional usage of the Halo are often lacking. Anecdotally, construct failures in multilevel corpectomies with stand-alone strut grafts have been reported and reviewed as high as 10-50% [33,68,89,94,96,107], whereas stand-alone grafts do not support or halter the reconstructed cervical lordosis in multisegmental constructs [91]. Recently, Ikenaga et al [52] reported a 85% fusion rate after 12 months in 112 multilevel corpectomies using long fibular grafts afixed with one screw caudally.…”

Section: Clinical Failures In Multilevel Anterior Cervical Constructsmentioning

confidence: 99%

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

et al. 2007

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In the future, there will be an increased number of cervical revision surgeries, including 4-and more-levels. But, there is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute to current knowledge, we want to share our experience with 4-and 5-level anterior cervical fusions in 26 cases in sight of a critical review of literature. At index procedure, almost 50% of our patients had previous cervical surgeries performed. Besides failed prior surgeries, indications included degenerative multilevel instability and spondylotic myelopathy with cervical kyphosis. An average of 4.1 levels was instrumented and fused using constrained (26.9%) and non-constrained (73.1%) screw-plate systems. At all, four patients had 3-level corpectomies, and three had additional posterior stabilization and fusion. Mean age of patients at index procedure was 54 years with a mean follow-up intervall of 30.9 months. Preoperative lordosis C2-7 was 6.5°in average, which measured a mean of 15.6°at last follow-up. Postoperative lordosis at fusion block was 14.4°in average, and 13.6°at last follow-up. In 34.6% of patients some kind of postoperative change in construct geometry was observed, but without any catastrophic construct failure. There were two delayed unions, but finally union rate was 100% without any need for the Halo device. Eleven patients (42.3%) showed an excellent outcome, twelve good (46.2%), one fair (3.8%), and two poor (7.7%). The study demonstrated that anterior-only instrumentations following segmental decompressions or use of the hybrid technique with discontinuous corpectomies can avoid the need for posterior supplemental surgery in 4-and 5-level surgeries. However, also the review of literature shows that decreased construct rigidity following more than 2-level corpectomies can demand 360°instrumentation and fusion. Concerning construct rigidity and radiolographic course, constrained plates did better than non-constrained ones. The discussion of our results are accompanied by a detailed review of literature, shedding light on the biomechanical challenges in multilevel cervical procedures and suggests conclusions.

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Section: Clinical Failures In Multilevel Anterior Cervical Constructsmentioning

confidence: 99%

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

et al. 2007

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“…in patients with ALS, MS, normotensive hydrocephalus) and even a risk of perioperative mortality, with a major morbidity rate of up to 22%, e.g. with corpectomy [29]. Twenty-five percent of patients with laminoplasty suffer from severe neck and shoulder pain for more than 3 months [18], with significant morbidity from the iliac crest donor site etc.…”

Section: Introductionmentioning

confidence: 99%

Conservative treatment versus surgery in spondylotic cervical myelopathy: a prospective randomised study

Kadaňka

Bednařík

Voháňka

et al. 2000

European Spine Journal

125

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IntroductionSpondylotic cervical myelopathy (SCM) is the most frequent cause of myelopathy in those over the age of 50 [48]. It is believed to have a generally progressive course over a period of years, with sudden acceleration especially following a slight head and neck injury, leading to significant disability [24,45,49]. The treatment of SCM remains a problem, particularly in the mild and moderate forms without rapid progression. There is no strong evidence to show that decompressive surgery with an anterior or posterior approach can improve the clinical outcome of the victims of this disease. This uncertainty persists despite the fact that decompression is a logical answer to the stenotic process, and that this approach is supAbstract A prospective randomised 2-year study was performed to compare the conservative and operative treatment of mild and moderate forms of spondylotic cervical myelopathy (SCM). Forty-eight patients presenting with the clinical syndrome of SCM, with a modified Japanese Orthopaedic Association (mJOA) score of 12 points or more, were randomised into two groups. Group A, treated conservatively, consisted of 27 patients, mean age 55.6 ± 8.6 years, while group B was treated surgically (21 patients, mean age 52.7 ± 8.1 years). The clinical outcome was measured by the mJOA score, recovery rate (RR), timed 10 m walk, score of daily activities (recorded by video and evaluated by two observers blinded to the therapy), and by the subjective assessment of the patients at 6, 12, and 24 months of the follow-up. There was, on average, no significant deterioration in mJOA score, recovery ratio, or timed 10 m walk within either group during the 2 years of follow-up. In the surgery group there was a slight decline in the scores for daily activities and subjective evaluation. A comparison of the two groups showed no significant differences in changes over time in mJOA score or quantified gait, but there were significant differences in the score of daily activities recorded by video at 24 months, which was a little lower in the surgical group, and also in RR and subjective evaluation, which were both worse in the surgical group at months 12 and 24. However, at month 6, this last parameter was significantly better in the surgical than in conservative group. Surgical treatment of mild and moderate forms of SCM in the present study design, comprising the patients with no or very slow, insidious progression and a relatively long duration of symptoms, did not show better results than conservative treatment over the 2-year follow-up.

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“…The incidence of iatrogenic VA injury in anterior cervical decompression procedures has been reported to range from 0.18 to 2.78 % [1,[19][20][21][22]. James et al [19] reported that VA injury can occur if decompression is asymmetric or overly aggressive.…”

Section: Discussionmentioning

confidence: 99%

Alterations in axial curvature of the cervical spine with a combination of rotation and extension in the conventional anterior cervical approach

et al. 2013

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Purpose Alterations of three-dimensional cervical curvature in conventional anterior cervical approach position are not well understood. The purpose of this study was to evaluate alignment changes of the cervical spine in the position. In addition, simulated corpectomy was evaluated with regard to sufficiency of decompression and perforation of the vertebral artery canal. Methods Fifty patients with cervical spinal disorders participated. Cervical CT scanning was performed in the neutral and supine position (N-position) and in extension and right rotation simulating the conventional anterior approach position (ER-position). Rotation at each vertebral level was measured. With simulation of anterior corpectomy in a vertical direction with a width of 17 mm, decompression width at the posterior wall of the vertebrae and the distance from each foramen of the vertebral artery (VA) were measured. Results In the ER-position, the cervical spine was rotated rightward by 37.2°± 6.2°between the occipital bone and C7. While the cervical spine was mainly rotated at C1/2, the subaxial vertebrae were also rotated by several degrees. Due to the subaxial rotation, the simulated corpectomy resulted in smaller decompression width on the left side and came closer to the VA canal on the right side. Conclusions In the ER-position, the degrees of right rotation of subaxial vertebrae were small but significant. Therefore, preoperative understanding of this alteration of cervical alignment is essential for performing safe and sufficient anterior corpectomy of the cervical spine.

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Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy

Cited by 256 publications

References 30 publications

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

Conservative treatment versus surgery in spondylotic cervical myelopathy: a prospective randomised study

Alterations in axial curvature of the cervical spine with a combination of rotation and extension in the conventional anterior cervical approach

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