Anterior cervical multilevel decompression and fusion using fibular strut as revision surgery for failed cervical laminoplasty

Abstract

Retrospective analyses of six cases. To describe six patients with previous failed laminoplasty who were subsequently managed by anterior cervical decompression and fusion (ACDF) using fibular strut as revision surgeries. While several complications and unsatisfactory results of cervical laminoplasty have been reported, there is no general consensus on how to best surgically treat these pathological conditions. Six patients, who had been treated by laminoplasty for cervical spondylotic myelopathy (n = 2) or ossification of posterior longitudinal ligament (OPLL, n = 4) and had unfavorable outcomes, underwent ACDF using autogenous fibular strut grafts. The pathological factors associated with the poor outcomes were intraforaminal spur, slip, spondylotic change, disc herniation, and increase of OPLL in size. Clinical outcomes were assessed by evaluating the modified Japanese Orthopedic Association score (JOA score) of cervical myelopathy, severity of radicular pains, axial pains, and perioperative complications. In addition, C2-7 angle and the presence of bony union were analyzed. The revision ACDF significantly increased the mean ± SD. JOA score, from 10.3 ± 3.9 to 13.5 ± 2.7 points (p = 0.028), with a recovery rate of 47.1 ± 26.7%. Radicular pain and axial pain also improved. C2-7 angle was not changed significantly. Solid fusion was achieved in all patients at 12.2 ± 4.2 months after revision surgery. ACDF with fibular strut graft was effective as a revision procedure for failed laminoplasty.