Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes

Lau, Darryl; Chou, Dean; Mummaneni, Praveen V.

doi:10.3171/2014.12.spine14545

Cited by 76 publications

(86 citation statements)

References 25 publications

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“…However, other research suggests that ASD is caused by the dual action of natural and accelerated degeneration of adjacent segments [28]. Other studies have shown that the incidence of ASD is significantly lower after anterior cervical fusion undertaken for multilevel disease than for single-level disease [29]. In our series of patients there was no evidence of ASD after a follow-up of 2.5 years.…”

Section: Adjacent Segment Degenerationcontrasting

confidence: 46%

Four Levels Anterior Cervical Discectomy and Fusion by Stand Alone PEEK Cages

Alaghory¹,

Soliman²,

Abdelhameed³

2018

OJMN

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Background: cervical spondylotic myelopathy is a common health problem that neurosurgeons face in Egypt. The aim of this study is to evaluate the efficacy of PEEK cage only in 4 levels anterior cervical discectomy as one of surgical option other than anterior cervical corpectomy, fixation by plat or posterior approach for cervical laminectomy, and assessment of post spinal surgery pain. Methods: this prospective study on 28 patients with cervical spondylotic myelopathy (CSM) over a period of 3 years (between April 2012 and April 2015) with mean period of follow up 30 months. We have done anterior cervical discectomy with fixation by cage only for all cases with perioperative assessment and scoring clinically and radiologically (Japanese Orthopaedic Association [JOA] scores, Visual Analogue Scale [VAS] scores for assessment of neck and arm pain, perioperative parameters (hospital stay, blood loss, operative time), the European Myelopathy Scoring (EMS) and Odom's criteria, and the incidence of complication,post spinal surgery pain assessment). Results: clinical outcome was excellent (28.55), good (50%) and fair (21.5) according to Odom criteria. The European Myelopathy Scoring (EMS), improved from 10 to 16. The mean JOA score improved from 10.1 ± 2.1 to 14.2 ± 2.3. Fusion failure had been seen in 4 patients in one level for each secondary to anterior displacement of the cage with no other major complications. Conclusion: 4 levels anterior cervical discectomy with PEEK cage only is an effective, save and less costly with less post operative complication and hospital stay and less post spinal surgery pain.

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Section: Adjacent Segment Degenerationcontrasting

confidence: 46%

Four Levels Anterior Cervical Discectomy and Fusion by Stand Alone PEEK Cages

Alaghory¹,

Soliman²,

Abdelhameed³

2018

OJMN

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“…For these reasons, its superiority has not been established. Only a small number of retrospective analyses have been done [45][46][47][48][49][50], and no randomized trials have been reported. Several meta-analyses indicated that ACDF is associated with less surgical complications and better post-operative alignment [51][52][53][54][55].…”

Section: Anterior Fusion By Discectomy Versus Corpectomymentioning

confidence: 99%

Degenerative Cervical Myelopathy

et al. 2015

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Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.

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“…[33][34][35]65 However, in the hands of an experienced surgeon, CC can be performed safely and provides excellent ventral decompression in patients with both CSM and/or OPLL. To the best of our knowledge, this study presents complications rates in the largest cohort of patients undergoing CC published in the literature.…”

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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Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes

Cited by 76 publications

References 25 publications

Four Levels Anterior Cervical Discectomy and Fusion by Stand Alone PEEK Cages

Four Levels Anterior Cervical Discectomy and Fusion by Stand Alone PEEK Cages

Degenerative Cervical Myelopathy

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

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