Long Segment Anterior Cervical Discectomy and Fusion, Including C2

Abstract

A retrospective study of thirteen patients undergoing 5-level anterior spinal surgery for cervical myelopathy.Objective: While limited literature exists in reviewing the treatment of high cervical pathology extending caudally, we believe long segment surgery beginning at C2-3 can be accomplished with good success and is an option more patients may benefit from. We aim to describe the technique in accessing the C2-C3 disk space and efficacy of treating multilevel disease beginning at the C2 vertebral body. This includes an extensive technical report and surgical pearls.Summary of Background Data: Compression at the level of C2 can be daunting to access because of steep approach required. Few studies have described the technique in reaching the C2 level, with less information describing the efficacy of a 5-level anterior fusion starting at C2. Methods: Patients who underwent surgery between 2000 and 2016 were identified utilizing the department billing database and ICD codes. Patients age, operative indications, levels treated, length of hospital stay, fusion outcome, and operative complications were explored. Independent analysis of fusion was performed. Results:The average length of hospital stay was 3.9 days. Eight patients reported significant improvement of hand weakness, numbness, and/or gait at 6 months follow-up. The most frequent complication was dysphagia (23%). One patient experienced recurrent symptoms secondary to nonunion, and another patient suffered a postoperative neurological worsening because of anterior spinal artery syndrome. Conclusion:This retrospective review discusses the technique to visualize and fully decompress C2-C3 spinal segments. In addition, we explored the efficacy and perioperative risk in long segment anterior cervical discectomy and fusion.

Upper cervical anterior fusion to C2 with temporary infrahyoid muscle detachment: A clinical case series and description of surgical technique

“…To our knowledge, previous case series studies of ACSS-C2, including multi-level fusion cases, have shown that the incidence of dysphagia is 21.4-77.8% [3,[14][15][16][17][18][19], although the operational de nitions of dysphagia varied in each study. Of these studies, two case series included cases of persistent dysphagia (symptoms were prolonged until the nal follow-up) [3,16] and cases of dyspnea that required unplanned reintubation.…”