“Skip” corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament

Dalbayrak, Sedat; Yılmaz, Mesut; Naderi, Sait

doi:10.3171/2009.7.spine08965

Cited by 41 publications

(32 citation statements)

References 35 publications

(56 reference statements)

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“…Skip corpectomies are usually performed in the setting of extensive ventral compression, and the preservation of the C-5 vertebral body is believed to confer greater stability and strength to the construct. 4,10 The extensive exposure and the use of 2 graft constructs might be considered factors contributing to the higher complication rates in this group of patients. If these were the only factors, then patients undergoing 3-level CC should also be at higher risk for complications.…”

Section: Discussionmentioning

confidence: 99%

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

Sarkar¹,

Nair²,

Rajshekhar³

2016

FOC

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OBJECTIVE 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). METHODS 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. RESULTS 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 < 0.001). CONCLUSIONS 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.

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Section: Discussionmentioning

confidence: 99%

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

Sarkar¹,

Nair²,

Rajshekhar³

2016

FOC

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“…Good results have been reported for 1-and 2-level cervical corpectomies; however, corpectomies of 3 levels or more are fraught with complications including graft fracture, graft pistoning, graft dislodgement, instrumentation failure, and pseudarthrosis. 4 Dalbayrak et al 4 have introduced the idea of the "skip" corpectomy, whereby the C-5 vertebral body is left intact and C-4 and C-6 corpectomies are performed for cervical spondylitic myelopathy and OPLL. They conclude that the C-5 body adds additional stability to the anterior cervical construct and the procedure still provides adequate decompression.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of cervical ossification of the posterior longitudinal ligament: natural history and the role of surgical decompression and stabilization

Sugrue¹,

McClendon²,

Halpin³

et al. 2011

FOC

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Object Ossification of the posterior longitudinal ligament (OPLL) is a complex multifactorial disease process combining both metabolic and biomechanical factors. The role for surgical intervention and choice of anterior or posterior approach is controversial. The object of this study was to review the literature and present a single-institution experience with surgical intervention for OPLL. Methods The authors performed a retrospective review of their institutional experience with surgical intervention for cervical OPLL. They also reviewed the English-language literature regarding the epidemiology, pathophysiology, natural history, and surgical intervention for OPLL. Results Review of the literature suggests an improved benefit for anterior decompression and stabilization or posterior decompression and stabilization compared with posterior decompression via laminectomy or laminoplasty. Both anterior and posterior approaches are safe and effective means of decompression of cervical stenosis in the setting of OPLL. Conclusions Anterior cervical decompression and reconstruction is a safe and appropriate treatment for cervical spondylitic myelopathy in the setting of OPLL. For patients with maintained cervical lordosis, posterior cervical decompression and stabilization is advocated. The use of laminectomy or laminoplasty is indicated in patients with preserved cervical lordosis and less than 60% of the spinal canal occupied by calcified ligament in a “hill-shaped” contour.

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“…As for ACDF these can all be supplemented with anterior plating to provide extra stability and increase fusion rates. Newer techniques that have shown promising results include skip corpectomy and combined corpectomy and adjacent level discectomy [33, 34]. …”

Section: Operative Techniquesmentioning

confidence: 99%

Operative Techniques for Cervical Radiculopathy and Myelopathy

Kavanagh

Butler

O’Byrne

et al. 2012

Advances in Orthopedics

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Cervical spondylosis is a common problem encountered in modern orthopaedic practice. It is associated with significant patient morbidity related to the consequent radiculopathic and myelopathic symptoms. Operative intervention for this condition is generally indicated if conservative measures fail; however there are some circumstances in which urgent surgical intervention is necessary. Planning any surgical intervention must take into account a number of variables including, but not limited to, the nature, location and extent of the pathology, a history of previous operative interventions, and patient co-morbidities. There are many different surgical options and a multitude of different procedures have been described using both the anterior and posterior approaches to the cervical spine. The use of autograft to achieve cervical fusion is still the gold standard with allograft showing similar results; however fusion techniques are constantly evolving with novel synthetic bone graft substitutes now widely available.

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“Skip” corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament

Cited by 41 publications

References 35 publications

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

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

Surgical management of cervical ossification of the posterior longitudinal ligament: natural history and the role of surgical decompression and stabilization

Operative Techniques for Cervical Radiculopathy and Myelopathy

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