The long-term results of anterior surgical reconstruction in patients with postlaminectomy cervical kyphosis

Abstract

Background context Postlaminectomy kyphosis of the cervical spine is a challenging condition to treat because it has a combination of an exposed cord, progressive kyphosis, segmental instability, and anterior neural compression. The ideal mode of surgical correction remains controversial. In terms of surgical strategy, there are few large series that have reported the long-term results of anterior surgical treatment of this condition. Purpose This study was designed to determine the long-term results and outcomes of anterior surgical treatment alone for the patients of postlaminectomy cervical kyphosis. Study design/setting This is a retrospective review of prospectively collected data in an academic institution. Patient sample The sample comprises 23 patients who underwent anterior reconstruction surgery for the treatment of postlaminectomy kyphosis. Outcome measures The outcome measures were neck disability index (NDI), visual analog scale (VAS) for neck and arm pain, Nurick grades, kyphosis angles, fusion status, and complications. Methods Two independent spine surgeons reviewed the completed medical records and radiographs of 23 patients who had undergone multilevel anterior cervical hybrid decompression (corpectomy and discectomy) with instrumented fusions for postlaminectomy kyphosis by one surgeon at an academic institution. The clinical and radiographic outcomes were measured by NDI, VAS for neck and arm pain, Nurick grades, kyphosis angles, and fusion status at the time of preoperative, postoperative, and the last follow-up. Results The mean follow-up was 44.5±31.0 months (range 24–120 months). The average preoperative kyphosis of 20.9° was significantly improved to a lordosis of 14.0° after surgery (p<.0001) and was maintained to a lordosis of 9.6° at the final follow-up (p<.0001). The average correction angle of kyphosis was 30.5±11.7°. The average preoperative, NDI, VAS, and Nurick grades were significantly improved at the last follow-up (all, p<.0001). The average levels of 0.9±0.7 corpectomy, 2.0±0.9 discectomy, and 3.8±1.4 anterior fusions were performed in each patient. Solid fusion was confirmed by computed tomography in all patients at a mean time of 3.8±1.2 months. There were six (26%) patients and seven (30.4%) complications: four (14.3%) graft-related complications (one implant displacement, one graft dislodgment, and one pseudarthrosis), one swallowing difficulty, one wound infection, one dura tear, and one pneumonia. Conclusions Our data suggest that multilevel anterior surgical treatment using hybrid decompression (corpectomy and discectomy) combined with instrumented fusion yields acceptable clinical and neurological improvement and effective correction of cervical kyphosis. The techniques used also appeared to decrease the incidence of graft-related complications compared with a previous report by the same author.