Radiological and Clinical Outcome after Multilevel Anterior Cervical Discectomy and/or Corpectomy and Fixation

Abstract

Background: Multilevel anterior cervical decompression and fixation of four and more levels is a common surgical procedure used for several diseases. Methods: We reviewed the radiological and clinical outcomes after anterior cervical discectomy or corpectomy and fixation of four and more levels in 85 patients (55 men and 30 women) with an average age of 59.6 years. Surgical indication was multilevel cervical degenerative myelopathy and radiculopathy in 72 (85%) patients, multilevel cervical spondylodiscitis in four (5%), complex traumatic cervical fractures in four (5%), metastatic cervical spine tumor in two (2%), and ossification of the posterior longitudinal ligament in three (3%) patients. Results: There were no severe intraoperative complications such as spinal cord or vertebral artery injury or dissection. Seventy-three patients had four, 10 patients had five, and two patients had six anterior cervical level fixations. The visual analog scale (VAS) and Japanese Orthopedic Association (mJOA) scale scores improved (6.9 to 1.3 (p < 0.001) and 13.9 to 16.5 (p < 0.001), respectively). The Cobb angle increased from 5.7° to 17.6° postoperatively (p < 0.001). Secondary posterior fixation was necessary in three cases due to pseudarthrosis. Conclusion: The anterior approach appears to be optimal for ventral compressive pathology and lordosis restoration to the cervical spine. Limitations of multiple level decompression and fixation included increasing pseudoarthrosis rates, especially after corpectomy, and increasing fused level numbers.

Anterior Cervical Corpectomy and Fusion for Degenerative and Traumatic Spine Disorders, Single-Center Experience of a Case Series of 119 Patients

“…While instrument failures and severe subsidence may lead to spinal cord injury and neurological deterioration, minor material movements seem to be of little clinical relevance, 1 , 15 , 18 which is supported by the findings of this study (Table 4 ). Most cases of minor material migration were not progressive and were not considered clinically relevant.…”

“…Additional surgery with PF can provide extra support to improve cervical stability and is sometimes performed at the index operation or later as supplementary surgery due to material failure or instability. 18 , 19 , 22 The aim of this study was to analyze and evaluate the outcome of 119 cases of ACCF in 3 different cohorts, CSM (n = 50), infectious and neoplastic processes (n = 14), and trauma (n = 55), and to examine to which extent supplementary PF was required to achieve stability.…”

“…This is in accordance with the current literature. 18 , 26 An observation is that the only case in the CSM cohort which needed surgical revision with PF was a 3-level ACCF. The overall revision rate with PF was 2% for CSM, 29% for infections and neoplasms, and 7% for trauma indicating a higher risk for revision surgery in pathologies affecting bone quality in the surgical area.…”

“… 1 , 2 , 8 , 13 , 14 , 17 While ACCF effectively decompresses the spinal cord, it is debated whether it can provide enough cervical stability, especially in multilevel ACCFs, or whether an additional posterior fixation (PF) is required. 2 , 3 , 12 , 14 , 18-20 Different pathologies may require different considerations when ACCF is performed.…”

The Effect of Rod Pattern, Outrigger, and Multiple Screw-Rod Constructs for Surgical Stabilization of the 3-Column Destabilized Cervical Spine - A Biomechanical Analysis and Introduction of a Novel Technique

“…Cervical corpectomy and multilevel reconstruction is indicated in patients with degenerative disorders and stenosis, spinal column destruction from fracture, infection, or neoplastic disease, and for the treatment of cervical deformity. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] The ideal construct pattern to be selected for each patient is difficult to define because spinal construct stability is the sum of instrumentation pattern, bone quality, number of fixation points used, anterior column support, and posterior tension band integrity, as well as spinal alignment and cervical balance. 4,[15][16][17][18][19][20][21][22] Likewise, anterior-only reconstruction of multilevel corpectomies using a cage and anterior cervical plate only is prone to failure.…”