Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy

Yang, Lei; Qi, Min; Chen, Huajiang; Yang, Lili; Wang, Xinwei; Shi, Guodong; Gao, Rui; Wang, Ce; Yuan, Wen

doi:10.1007/s00586-012-2323-y

Cited by 97 publications

(79 citation statements)

References 18 publications

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“…13,29,30,34 In fact, compared with the published complication rates of standard corpectomy and discectomy, our complication rates remain within the lower end of those ranges (10%-21%). 6,7,11,26 These findings suggest that the anterior sequential interbody dilation technique has a risk profile similar to those in previously published anterior surgical series.…”

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confidence: 82%

A controlled anterior sequential interbody dilation technique for correction of cervical kyphosis

Lau¹,

Ziewacz²,

Le³

et al. 2015

SPI

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OBJECT Cervical kyphosis can lead to spinal instability, spinal cord injury, and disability. The correction of cervical kyphosis is technically challenging, especially in severe cases. The authors describe the anterior sequential interbody dilation technique for the treatment of cervical kyphosis and evaluate perioperative outcomes, degree of correction, and long-term follow-up outcomes associated with the technique. METHODS In the period from 2006 to 2011, a consecutive cohort of adults with cervical kyphosis (Cobb angles ≥ 0°) underwent sequential interbody dilation, a technique entailing incrementally increased interbody distraction with the sequential placement of larger spacers (at least 1 mm) in the discectomy and/or corpectomy spaces. The authors retrospectively reviewed these patients, and primary outcomes of interest included kyphosis correction, blood loss, hospital stay, complications, Nurick grade, pain, reoperation, and pseudarthrosis. A subgroup analysis among patients with preoperative kyphosis of 0°–9° (mild), 10°–19° (moderate), and ≥ 20° (severe) was performed. RESULTS One hundred patients were included in the study: 74 with mild preoperative cervical kyphosis, 19 with moderate, and 7 with severe. The mean patient age was 53.1 years, and 54.0% of the patients were male. Mean estimated blood loss was 305.6 ml, and the mean length of hospital stay was 5.2 days. The overall complication rate was 9.0%, and there were no deaths. Sixteen percent of patients underwent supplemental posterior fusion. There was significant correction in cervical alignment (p < 0.001), and the mean overall kyphosis correction was 12.4°. Patients with severe preoperative kyphosis gained a correction of 24.7°, those with moderate kyphosis gained 17.8°, and those with mild kyphosis gained 10.1°. A mean correction of 32.0° was obtained if 5 levels were addressed. The mean follow-up was 26.8 months. The reoperation rate was 4.7%. At follow-up, there was significant improvement in visual analog scale neck pain (p = 0.020) and Nurick grade (p = 0.037). The pseudarthrosis rate was 6.3%. CONCLUSIONS Sequential interbody dilation is a feasible and effective method of correcting cervical kyphosis. Complications and reoperation rates are low. Similar benefits are seen among all severities of kyphosis, and greater correction can be achieved in more severe cases.

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supporting

confidence: 82%

A controlled anterior sequential interbody dilation technique for correction of cervical kyphosis

Lau¹,

Ziewacz²,

Le³

et al. 2015

SPI

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“…Both techniques seem to have similar clinical outcomes and fusion rates when treating two adjacent levels [1]. The number of complications such as cage subsidence, dysphagia, and hoarness of nerve root palsy, increases in double level corpectomies [3]. We therefore restrict the indication for a corpectomy to one vertebra.…”

Section: Discussionmentioning

confidence: 99%

“…This technique requires bone graft harvesting from the iliac crest. The use of a titanium mesh cage filled with autologous bone from the resected vertebra itself has been described as an alternative reconstruction technique after corpectomy [3]. Additional stabilization using an anterior cervical plate is mandatory after cage reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Anterior corpectomy and fusion for two adjacent levels of cervical stenosis

et al. 2013

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“…Surgical interventions to ameliorate progressive symptoms in cervical spondylotic myelopathy (CSM) have yielded good results via various approaches [1][2][3][4][5][6][7]. The oblique corpectomy has been used for over two decades and provides adequate decompression without the need for a graft or a stabilization device [8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Reduction in range of cervical motion on serial long-term follow-up in patients undergoing oblique corpectomy for cervical spondylotic myelopathy

et al. 2013

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Purpose To determine whether motion preservation following oblique cervical corpectomy (OCC) for cervical spondylotic myelopathy (CSM) persists with serial followup. Methods We included 28 patients with preoperative and at least two serial follow-up neutral and dynamic cervical spine radiographs who underwent OCC for CSM. Patients with an ossified posterior longitudinal ligament (OPLL) were excluded. Changes in sagittal curvature, segmental and whole spine range of motion (ROM) were measured. Nathan's system graded anterior osteophyte formation. Neurological function was measured by Nurick's grade and modified Japanese Orthopedic Association (JOA) scores. ResultsThe majority (23 patients) had a single or 2-level corpectomy. The average duration of follow-up was 45 months. The Nurick's grade and the JOA scores showed statistically significant improvements after surgery (p \ 0.001). 17 % of patients with preoperative lordotic spines had a loss of lordosis at last follow-up, but with no clinical worsening. 77 % of the whole spine ROM and 62 % of segmental ROM was preserved at last follow-up. The whole spine and segmental ROM decreased by 11.2°a nd 10.9°, respectively (p B 0.001). Patients with a greater range of segmental movement preoperatively had a statistically greater range of movement at follow-up. The analysis of serial radiographs indicated that the range of movement of the whole spine and the range of movement at the segmental spine levels significantly reduced during the follow-up period. Nathan's grade showed increase in osteophytosis in more than two-thirds of the patients (p B 0.01). The whole spine range of movement at followup significantly correlated with Nathan's grade. Conclusions Although the OCC preserves segmental and whole spine ROM, serial measurements show a progressive decrease in ROM albeit without clinical worsening. The reduction in this ROM is probably related to degenerative ossification of spinal ligaments.

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Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy

Cited by 97 publications

References 18 publications

A controlled anterior sequential interbody dilation technique for correction of cervical kyphosis

A controlled anterior sequential interbody dilation technique for correction of cervical kyphosis

Anterior corpectomy and fusion for two adjacent levels of cervical stenosis

Reduction in range of cervical motion on serial long-term follow-up in patients undergoing oblique corpectomy for cervical spondylotic myelopathy

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