Single-stage anterior–posterior decompression and stabilization for complex cervical spine disorders

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>To evaluate the applicability and safety of single-stage combined anterior–posterior decompression and fusion for complex cervical spine disorders, the authors retrospectively reviewed 72 consecutive procedures of this type performed at their respective institutions.</jats:p></jats:sec> <jats:sec> <jats:title>Methods </jats:title> <jats:p>The indications for decompression and stabilization included: postlaminectomy kyphosis (15 patients), trauma (19 patients), spondylosis and congenital stenosis (32 patients), and ossification of the posterior longitudinal ligament (six patients). All patients underwent anterior cervical corpectomies in which allograft fibula and plates were placed, with 89% of patients undergoing two- or three-level procedures (range one–four levels). Lateral mass plating with autograft (morselized iliac crest) fusion was performed in all patients while the same anesthetic agent was still in effect. A hard cervical collar was used postoperatively in all patients (mean 13 weeks). All patients were followed for a minimum of 2 years (mean 29 months).</jats:p> <jats:p>Fusion was determined to be successful in all 72 patients (100%). Although the short-term morbidity rate reached 32%, the significant long-term morbidity rate was only 5%. At the 2-year follow-up examination, anterior cervical plate dislodgment was seen in one patient, and 16 of the 516 lateral mass screws implanted were observed to have partially backed out. However, there were no cases of nerve root injury, strut graft extrusion, or anterior plate or screw fracture. There were no clinically significant hardware complications and no patient required repeated operation.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions </jats:title> <jats:p>The combined single-stage anterior–posterior decompression, reconstruction, and instrumentation procedure represents a viable option in the treatment of a select group of patients with complex cervical spinal disorders. The technique provides immediate rigid stabilization of the cervical spine, prevents anterior plate failure or strut graft extrusion, and eliminates the need for halo immobilization postoperatively. Furthermore, a higher rate of fusion is achieved with this combined approach than with the anterior approach alone.</jats:p></jats:sec>

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

“…88.5% of our patients showed good or excellent outcome following 27.4 months in average. Our follow-up and sample size was comparable to previous studies (21.5 and 18.5, respectively [12,25,28,48,49,52,91,101]). If clinical outcome was addressed in previous studies, it was satisfactory in more than 60-80% [28,49,52,70].…”

“…The surgical complications in our series encountering only 4-and 5-level anterior fusions are comparable, and even less than compared to similar studies [6,25,77,101,110,111,126]. According to Lee et al, 50% of patients will suffer short-term dysphagia and about 10% have long-term sequelae following ACDFs [63].…”

“…Biomechanical studies [24,53,54,61,75,86,95,99,100,102,104] and previous clinical studies [11, 22, 48, 55, 61, 62, 66, 73, 75, 90, 95, 100-102, 104, 118] called into question the use of anterior devices in multilevel fusions and corpectomy cases, and support the addition of posterior stabilization, particularly that of pedicle screw fixation [58,59,61,97,100]. However, one has to consider that with the biomechanical advantage of supplemental posterior stabilization is the addition of a second significant surgery and added risks, particularly in elderly and frail patients.…”

“…All patients had additional posterior fixation, no patient experienced construct failure. Schultz et al [101] reported on successful 3-level corpectomies in 30 cases and 4-level in two following anterior decompression, fibula strut graft placement, ACPS, and posterior fixation. In a series of Rogers et al [92], including 3-level corpectomies in ten patients and four in one, there were no failures but a 100% fusion rate following anterior strut grafting and posterior fixation, too.…”

Posterior cervical fixation following laminectomy: a stress analysis of three techniques

“…In summary, it is becoming increasingly evident that rigid posterior instrumentation is an important method of stabilization after long anterior column reconstructions in the setting of cervical spondylosis [5,6].…”