Abstract
Anterior cervical corpectomy and fusion (ACCF) is one of the main surgical strategies for the management of multilevel cervical spondylotic myelopathy (MCSM). High complication rates of graft bone fracture, resorption, displacement, and fusion collapse or pseudarthrosis have been previously reported. The strategies to prevent the aforementioned complications include using fresh frozen cortical strut allograft (FFCSA) to keep most of the original bone quality and using additional anterior plate fixation to improve the fusion stability and union rate. In this study, we evaluated 4-year follow-ups for surgical outcomes and analyzed the risk factors of MCSM patients who received 2-level ACCF with FFCSA and titanium dynamic plate fixation. We retrospectively collected preoperative and postoperative radiographic and clinical data of patients from 2005 to 2009; the inclusion criteria were having been diagnosed as MCSM and having received 2-level ACCF with an FFCSA fibular shaft and an anterior dynamic plate. The cervical curvature lordosis improved and the neurogenic function recovered well postoperatively. Visual analog scale for neck pain and neck disability index scores both decreased after 12 and 48 months following surgery. The Japanese Orthopaedic Association score recovery rate at postoperative 4 years was 87.5%. Fusion rates achieved 100% at 12 months. The preoperative Nurick score seemed to be the only significant risk factor correlated with the functional recovery rate at 4 years after the surgery. In conclusion, based on a minimum 4-year follow-up of 2-level ACCF with FFCSA and dynamic titanium plates for patients with MCSM, the surgical results were satisfying and the complication rates were low.
Highlights
Multilevel cervical spondylotic myelopathy (MCSM) is a common cause of neurologic deficits that decrease quality of life
In the 1990s, favorable results of long level ACCF reconstructed with cortical strut allograft (CSA) were reported [4], but high complication rates of graft bone fracture, resorption, displacement, and fusion collapse or pseudarthrosis were reported [5]
This study presents positive surgical outcomes of 2-level ACCF for the patients with MCSM
Summary
Multilevel cervical spondylotic myelopathy (MCSM) is a common cause of neurologic deficits that decrease quality of life. The surgical strategies of decompression for MCSM include both anterior and posterior approaches [1, 2]. Cortical strut allograft for anterior cervical corpectomy and fusion combined approaches is made on the basis of (1) disc or behind-vertebral-body levels of spinal cord compression, (2) sagittal alignment of cervical spine curvature, (3) location of compressive abnormality, (4) presence of preoperative neck pain, and (5) previous operations [3]. Strategies to prevent the aforementioned complications include using fresh frozen CSA (FFCSA) to keep most of the original bone quality and using additional anterior plate fixation to improve the fusion stability and union rate [11,12,13]. ACCF with additional dynamic plate fixation are commonly performed in recent studies [15, 16]
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