Abstract
BackgroundEctopic gas in the graft is occasionally encountered upon follow-up computed tomography (CT) after anterior cervical corpectomy and fusion (ACCF). However, most cases lack inflammatory responses and manifestations of infection. Although the clinical significance of ectopic gas in the graft has not yet been established, to the best of our knowledge, no previous studies have described ectopic gas in the graft after ACCF. This study evaluated ectopic gas in the fibular graft upon follow-up CT after ACCF.MethodsWe reviewed 112 patients who underwent ACCF and follow-up CT, with a minimum follow-up period of 3 years. CT images were retrospectively reviewed to confirm the presence of ectopic gas in the graft and bone fusion. Bone fusion was defined as follows: mobility less than 2 mm between spinous processes on the flection-extension radiograph or a bone bridge on CT images.ResultsOf the 112 patients, 30 (27%) patients had ectopic gas in the fibular grafts. Among them, ectopic gas was initially observed 3 months after surgery (early onset) in 23 (77%) patients and 6 months after surgery (late-onset) in the remaining seven (23%) patients. Upon the latest follow-up CT, ectopic gas more frequently remained in late-onset (4/7, 57%) rather than in early-onset (3/23, 13%) cases (p = 0.033). Bone fusion was not observed when CT images exhibited ectopic gas in the graft, whereas ectopic gas was not observed when CT images exhibited bone fusion.ConclusionEctopic gas in the fibular graft was observed at both early and late-onset after ACCF; late-onset gas remained significantly. The remaining gas was strongly associated with pseudoarthrosis; therefore, pseudoarthrosis should be considered when ectopic gas in the graft is observed on CT images.
Highlights
Anterior cervical corpectomy and fusion (ACCF) and strut bone grafting is an established surgical option for the treatment of ossification of the posterior longitudinal ligament (OPLL) and cervical spondylotic myelopathy (CSM)
The ilium and fibula strut bones are used in routine surgical procedures to correct corpectomy
Materials and methods This study was approved by the human research committee of the Institutional Review Board, and it complied with the guidelines outlined in the Health Insurance Portability and Accountability Act of 1996
Summary
Anterior cervical corpectomy and fusion (ACCF) and strut bone grafting is an established surgical option for the treatment of ossification of the posterior longitudinal ligament (OPLL) and cervical spondylotic myelopathy (CSM). Kuhns et al stated that pseudarthrosis after anterior cervical discectomy and fusion (ACDF) has been recognized as a cause of continued cervical pain and unsatisfactory outcomes [5], which can necessitate additional anterior or posterior surgery [4,5,6]. Ectopic gas in the graft is occasionally encountered upon follow-up computed tomography (CT) after ACCF, while the majority of cases lack inflammatory responses and manifestations of infection. The purpose of this study was to evaluate ectopic gas in the graft upon follow-up CT after ACCF and to determine the clinical significance from the perspective of pseudoarthrosis. Ectopic gas in the graft is occasionally encountered upon follow-up computed tomography (CT) after anterior cervical corpectomy and fusion (ACCF). This study evaluated ectopic gas in the fibular graft upon follow-up CT after ACCF
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