Anterior Cervical Corpectomy Research Articles

Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

Abstract Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5-C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, which may be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.

Anterior Cervical Corpectomy and Fusion for Degenerative and Traumatic Spine Disorders, Single-Center Experience of a Case Series of 119 Patients

Tatter, Charles MD; Persson, Oscar MD, PhD; Burström, Gustav MD; Edström, Erik MD, PhD; Elmi-Terander, Adrian MD, PhD Author Information

Anterior Cervical Corpectomy with Fusion versus Anterior Hybrid Fusion Surgery for Patients with Severe Ossification of the Posterior Longitudinal Ligament Involving Three or More Levels: A Retrospective Comparative Study

Various studies have found a high incidence of early graft dislodgement after multilevel corpectomy. Although a hybrid fusion technique was developed to resolve implant failure, the hybrid and conventional techniques have not been clearly compared in terms of perioperative complications in patients with severe ossification of the posterior longitudinal ligament (OPLL) involving three or more levels. The purpose of this study was to compare clinical and radiologic outcomes between anterior cervical corpectomy with fusion (ACCF) and anterior hybrid fusion for the treatment of multilevel cervical OPLL. We therefore retrospectively reviewed the clinical and radiologic data of 53 consecutive patients who underwent anterior fusion to treat cervical OPLL: 30 underwent ACCF and 23 underwent anterior hybrid fusion. All patients completed 2 years of follow-ups. Implant migration was defined as subsidence > 3 mm. There were no significant differences in demographics or clinical characteristics between the ACCF and hybrid groups. Early implant failure occurred significantly more frequently in the ACCF group (5 cases, 16.7%) compared with the hybrid group (0 cases, 0%). The fusion rate was 80% in the ACCF group and 100% in the hybrid group. Although both procedures can achieve satisfactory neurologic outcomes for multilevel OPLL patients, hybrid fusion likely provides better biomechanical stability than the conventional ACCF technique.

Cervical Spine Trauma in East Africa: Presentation, Treatment, and Mortality.

Cervical spine trauma (CST) leads to devastating neurologic injuries. In a cohort of CST patients from a major East Africa referral center, we sought to (a) describe presentation and operative treatment patterns, (b) report predictors of neurologic improvement, and (c) assess predictors of mortality. A retrospective, cohort study of CST patients presenting to a tertiary hospital in Dar Es Salaam, Tanzania, was performed. Demographic, injury, and operative data were collected. Neurologic exam on admission/discharge and in-hospital mortality were recorded. Univariate/multivariate logistic regression assessed predictors of operative treatment, neurologic improvement, and mortality. Of 101 patients with CST, 25 (24.8%) were treated operatively on a median postadmission day 16.0 (7.0-25.0). Twenty-six patients (25.7%) died, with 3 (12.0%) in the operative cohort and 23 (30.3%) in the nonoperative cohort. The most common fracture pattern was bilateral facet dislocation (26.7%). Posterior cervical laminectomy and fusion and anterior cervical corpectomy were the 2 most common procedures. Undergoing surgery was associated with an injury at the C4-C7 region versus occiput-C3 region (odds ratio [OR] 6.36, 95% confidence interval [CI] 1.71-32.28, P = .011) and an incomplete injury (OR 3.64; 95% CI 1.19-12.25; P = .029). Twelve patients (15.8%) improved neurologically, out of the 76 total patients with a recorded discharge exam. Having a complete injury was associated with increased odds of mortality (OR 11.75, 95% CI 3.29-54.72, P < .001), and longer time from injury to admission was associated with decreased odds of mortality (OR 0.66, 95% CI 0.48-0.85, P = .006). Those most likely to undergo surgery had C4-C7 injuries and incomplete spinal cord injuries. The odds of mortality increased with complete spinal cord injuries and shorter time from injury to admission, probably due to more severely injured patients dying early within 24-48 hours of injury. Thus, patients living long enough to present to the hospital may represent a self-selecting population of more stable patients. These results underscore the severity and uniqueness of CST in a less-resourced setting. 4.

Effectiveness of three-dimensional printing artificial vertebral body and interbody fusion Cage in anterior cervical surgery

To evaluate the effectiveness of three-dimensional (3D) printing artificial vertebral body and interbody fusion Cage in anterior cervical disectomy and fusion (ACCF) combined with anterior cervical corpectomy and fusion (ACDF). The clinical data of 29 patients with multilevel cervical spondylotic myelopathy who underwent ACCF combined with ACDF between May 2018 and December 2019 were retrospectively analyzed. Among them, 13 patients were treated with 3D printing artificial vertebral body and 3D printing Cage as 3D printing group and 16 patients with ordinary titanium mesh Cage (TMC) and Cage as TMC group. There was no significant difference in gender, age, surgical segment, Nurick grade, disease duration, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, and Cobb angle of fusion segment between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospitalization stay, complications, and implant fusion at last follow-up were recorded and compared between the two groups; JOA score was used to evaluate neurological function before operation, immediately after operation, at 6 months after operation, and at last follow-up; VAS score was used to evaluate upper limb and neck pain. Cobb angle of fusion segment was measured and the difference between the last follow-up and the immediate after operation was calculated. The height of the anterior border (HAB) and the height of the posterior border (HPB) were measured immediately after operation, at 6 months after operation, and at last follow-up, and the subsidence of implant was calculated. The operation time of 3D printing group was significantly less than that of TMC group ( t=3.336, P=0.002); there was no significant difference in hospitalization stay and intraoperative blood loss between the two groups ( P>0.05). All patients were followed up 12-19 months (mean, 16 months). There was no obvious complication in both groups. There were significant differences in JOA score, VAS score, and Cobb angle at each time point between the two groups ( P<0.05). There was an interaction between time and group in the JOA score ( F=3.705, P=0.025). With time, the increase in JOA score was different between the 3D printing group and the TMC group, and the increase in the 3D printing group was greater. There was no interaction between time and group in the VAS score ( F=3.038, P=0.065), and there was no significant difference in the score at each time point between the two groups ( F=0.173, P=0.681). The time of the Cobb angle interacted with the group ( F=15.581, P=0.000). With time, the Cobb angle of the 3D printing group and the TMC group changed differently. Among them, the 3D printing group increased more and the TMC group decreased more. At last follow-up, there was no significant difference in the improvement rate of JOA score between the two groups ( t=0.681, P=0.502), but the Cobb angle difference of the 3D printing group was significantly smaller than that of the TMC group ( t=5.754, P=0.000). At last follow-up, the implant fusion rate of the 3D printing group and TMC group were 92.3% (12/13) and 87.5% (14/16), respectively, and the difference was not significant ( P=1.000). The incidence of implant settlement in the 3D printing group and TMC group at 6 months after operation was 15.4% (2/13) and 18.8% (3/16), respectively, and at last follow-up were 30.8% (4/13) and 56.3% (9/16), respectively, the differences were not significant ( P=1.000; P=0.264). The difference of HAB and the difference of HPB in the 3D printing group at 6 months after operation and last follow-up were significantly lower than those in the TMC group ( P<0.05). For patients with multilevel cervical spondylotic myelopathy undergoing ACCF combined with ACDF, compared with TMC and Cage, 3D printing artificial vertebrae body and 3D printing Cage have the advantages of shorter operation time, better reduction of height loss of fusion vertebral body, and maintenance of cervical physiological curvature, the early effectiveness is better.

Construction of a new cervical anatomically adaptive titanium mesh cage based on measurements of cervical geometry: A morphological and cadaveric study.

Mismatch between the titanium mesh cage and cervical geometries is an important factor that induces subsidence in anterior cervical corpectomy and fusion (ACCF). The aim of the present study was to construct a new quadrate anatomically adaptive titanium mesh cage (AA-TMC) that matches well with the cervical geometries and segmental alignment in one- and two-level ACCF. Computed tomography (CT) scans of 54 individuals were used to measure the cervical endplate geometries. X-rays of 74 young individuals were used to measure the intervertebral body angle (IBA) and intervertebral body height (IBH) of the surgical segments. The AA-TMC was designed based on these measured parameters. A total of 18 cervical cadaveric specimens underwent successive one- and two-level ACCF using the AA-TMC. Postoperatively, the specimens underwent CT scanning to assess the degree of matching of the TMC-endplate interface (TEI), IBA and IBH. A TEI interval <0.5 mm was considered well matching. In the sagittal plane, 93.8% of the inferior endplates were arched, whereas 94.8% of the superior endplates were flat. In the coronal plane, 82.9% of the inferior endplates and 93.8% of the superior endplates were flat. A total of 91.7 and 94.4% of the TEIs were well matched in one- and two-level ACCF, respectively. The postoperative IBA and IBH values were consistent with the values of young individuals. The AA-TMC achieved good matching with cervical geometries and segmental alignment in one- and two-level ACCF, and is proposed for use in ACCF to increase the contact at the TEI and achieve sufficient lordosis restoration.

Use of a nano-hydroxyapatite/polyamide composite in anterior cervical subtotal corpectomy and fusion

This study aimed to explore the safety and efficacy of using nano-hydroxyapatite/polyamide (N-HA/PA) composite in anterior cervical vertebral body subtotal corpectomy and interbody fusion. Total 50 patients with cervical spondylotic myelopathy were enrolled to undergo anterior cervical spondylectomy. Bone graft pedicles were compounded with N-HA/PA and intervertebral body fusion was performed. Study outcomes included surgical efficacy and the degree of fusion. Patients in whom vertebral body fusion was performed with N-HA/PA composite pedicles had significantly improved symptoms. The postoperative Japanese Orthopaedic Association scores increased to 18.56±4.37 from 11.37±3.52, reflecting an improvement rate of 87.3%. The composite pedicle fusion rate was 96.4%. Therefore, N-HA/PA composite pedicle as a bone graft material in fusion surgery provides significant therapeutic efficacy. Moreover, the composite pedicle fusion rate is high, making it ideal for anterior cervical vertebral body subtotal corpectomy and fusion.

137. Correction, maintenance of cervical alignment and revision rates: three-level ACDF versus corpectomy ACDF hybrid procedures

<h3>BACKGROUND CONTEXT</h3> Anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and hybrids (combination ACCF-ACDF) are common procedures used to treat symptomatic cervical spondylosis. Although there is a relative abundance of literature comparing 1-level ACCF vs 2-level ACDF and 2-level ACCF vs 3-level ACDF, detailed comparisons of 3-level ACDF vs hybrid procedures have not been extensively addressed. <h3>PURPOSE</h3> The objective of this study is to compare 3 and 12-month radiographic sagittal parameters and patient reported outcomes (PROs) in patients who underwent 3-level ACDF or a hybrid procedure. <h3>STUDY DESIGN/SETTING</h3> Longitudinal observational comparative cohorts from a large, multisurgeon database. <h3>PATIENT SAMPLE</h3> Patients who underwent a 3-level ACDF (3L-ACDF, N=47) or 1-level corpectomy/1-level ACDF (Hybrid, N=52) with at least a 12-month postop data available were identified. <h3>OUTCOME MEASURES</h3> EuroQOL-5D (EQ-5D), Neck Disability Index (NDI), neck and arm pain. <h3>Methods</h3> Standard demographic, surgical and (PROs) were collected in addition to pre- and postoperative radiographic data including C2 plumb line (C2PL), C2-C7 lordosis (CL), segmental lordosis (SL), and T1 slope (T1S). <h3>Results</h3> The two cohorts were similar in terms of demographics at baseline. At 3 months postop, CL (9.04°vs -2.12°, p=0.00) and SL (6.06°vs -2.26°, p=0.003) were significantly greater in the 3L-ACDF group versus the HYBRID group. This significant difference was maintained at 12 months postop for CL (6.62°vs -0.60°, p=0.015) but not for SL (2.36°vs -1.09°, p=0.199). There were no differences in PROs between the two groups prior to surgery, at 3 months postop, or at 12 months postop. Seven patients required revision surgery in the 1-year study period (1 in the 3L-ACDF, and 6 in the Hybrid p<0.001). <h3>Conclusions</h3> Three-level ACDF resulted in greater C2-C7 lordosis and segmental lordosis postoperatively, which was maintained at 1 year for cervical lordosis. While patient reported outcomes were similar between the groups, patients with hybrid instrumentation required significantly more revision surgeries than those treated with 3-level ACDF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

A novel anatomic titanium mesh cage for reducing the subsidence rate after anterior cervical corpectomy: a finite element study

Fusion with a titanium mesh cage (TMC) has become popular as a conventional method after cervical anterior corpectomy, but postoperative TMC subsidence has often been reported in the literature. We designed a novel anatomic cervical TMC to reduce the postoperative subsidence rate. According to the test process specified in the American Society of Testing Materials (ASTM) F2267 standard, three-dimensional finite element analysis was used to compare the anti-subsidence characteristics of a traditional TMC (TTMC) and novel TMC (NTMC). Through analysis, the relative propensity values of a device to subside (Kp) of the TTMC and NTMC were 665.5 N/mm and 1007.2 N/mm, respectively. A higher Kp measurement is generally expected to indicate that the device is more resistant to subsidence into a vertebral body. The results showed that the novel anatomic titanium mesh cage (NTMC) significantly improved the anti-subsidence performance after anterior cervical corpectomy and fusion (ACCF), which was approximately 51.3% higher than that of the traditional titanium mesh cage.

Clinicoradiological Outcome of 3 or More Levels of Anterior Cervical Corpectomy and Reconstruction.

Studies reporting multilevel anterior cervical corpectomy (>2 levels) and reconstruction in patients with long-segment anterior cervical compression are few and surgical outcomes are variable with increased surgical morbidity and a high incidence of graft-related complications. The aim of this study is to evaluate the effectiveness and safety of cervical corpectomy and anterior reconstruction of 3 or more levels in patients with long-segment anterior cervical compression. We retrospectively reviewed patients who had undergone 3 or more levels of anterior cervical corpectomy and reconstruction from 2014 to 2018. Clinical and radiological parameters such as Nurick grading, modified Japanese Orthopedic Association (mJOA) score, cervical segmental angle, cervical sagittal angle, graft subsidence, and fusion rate were evaluated preoperatively and at a 2-year follow-up. Patients were divided into 2 groups according to their anterior reconstruction, either with fibular strut autogenous graft or titanium mesh cage and rigid anterior cervical plating for subgroup analysis. Patients whose bone stock was found to be poor had undergone posterior instrumentation as a staged procedure. There were 48 patients (mean age: 58.17 years) in the cohort: 42 had undergone 3-level and 6 had undergone 4-level cervical corpectomy with an ossified posterior longitudinal ligament and multilevel cervical spondylotic myelopathy being the main surgical indications. C5 to C7 corpectomy was most common. Of the cohort, 83.4% had standalone anterior reconstruction and only 8 patients (16.6%) had supplementation with posterior instrumentation. Our subgroup analysis showed statistically significant change in Nurick grading, mJOA score, cervical segmental angle, and sagittal angle in both groups at a 2-year follow-up (P < .05). Overall fusion rate was 89.5%. Decreased incidence of graft subsidence, statistically significant less graft subsidence (P = .002) and a higher fusion rate (P = .001) were noted in titanium mesh cage group at 2-year follow-up. Multilevel anterior cervical corpectomy and reconstruction is a safe and efficacious procedure. A titanium mesh cage filled with autogenous bone graft and a rigid anterior cervical plate gives best results. Posterior instrumentation should be considered along with a multilevel cervical corpectomy construct in patients with poor bone stock. 4.

Imaging study of soft tissue swelling after anterior cervical corpectomy

To study the changes of anterior soft tissue swelling after anterior cervical subtotal corpectomy, titanium mesh fusion and internal fixation. From November 2015 to July 2018, 151 patients with cervical spondylotic myelopathy were treated with anterior single corpectomy, titanium mesh fusion and internal fixation, including 109 males and 42 females, aged 44 to 81 (59.77±8.34) years. Through postoperative follow up observation, the C2-C7 level of anterior intervertebral space distance was measured to evaluate the changes of anterior soft tissue swelling. All patients were followed up for 15 to 40(28.00±3.52) months. One week after the operation, the swelling of anterior soft tissue reached the peak, and then decreased. At 8 months after the operation, the swelling of anterior soft tissue on C5, C6 and C7 plane returned to normal. At 12 months after the operation, the swelling of anterior soft tissue on C2, C3 and C4 plane returned to normal. Anterior subtotal cervical corpectomy, titanium mesh bone graft fusion and internal fixation can cause swelling of the anterior soft tissue. One week after operation, we should pay more attention to the aggravation of the swelling of the anterior soft tissue to avoid the occurrence of dysphagia, respiratory obstruction, asphyxia and other complications.

2021 Canadian Spine Society Abstracts.

# Abstract 45. Determining clinically important improvement following surgery for degenerative conditions of the spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) Registry {#article-title-2} There is significant variability in clinically important improvement (CII)

Intraoperative O-arm navigation guided anterior cervical surgery; A technical note and case series

BackgroundNavigation surgery is becoming very popular for anterior cervical surgery. However, one difficult problem for anterior cervical surgery is setting the reference frame (RF), due to the lack of reliable structures. If the RF is attached to the head holder or operation table instead of the patient, the accuracy of navigation is not good. Materials and methodsThis retrospective study included six patients who underwent anterior cervical surgeries with O-arm navigation. The RF was attached to the Caspar retractor using a special adaptor. Patients comprised three men and three women with a mean age of 62.8 years. Anterior cervical discectomy and fusion was performed in three cases, and anterior cervical corpectomy and fusion in three cases. We evaluated the accuracy of navigation, surgical time, intraoperative blood loss, complications, bony fusion, and clinical results. ResultsMean accuracy of anterior navigation was 1.1 ± 0.7 mm (range, 0–2 mm). Mean surgical time and blood loss were 166 ± 39 min (range, 121–359 min) and 280 ± 189 ml (range, 50–600 ml), respectively. Complications comprised one case of postoperative C5 palsy that recovered within 6 months. Mean Japanese Orthopedic Association (JOA) recovery rate was 52.4% (range, 20–100%). Adequate decompression and solid fusion were obtained in all cases. ConclusionsIntraoperative O-arm navigation-guided anterior cervical decompression and fusion is an effective technique for achieving precise decompression. This new navigation technique provides excellent results for severe cervical ossification of the posterior longitudinal ligament (OPLL) with minimum risk of adverse events from intraoperative radiation. We advocate the use of this novel technique in cases of cervical canal stenosis due to large disc osteophyte complex and OPLL, and also in cases of distorted cervical anatomy due to deformity, tumor, or revision surgery.

Comparison of Postoperative Complications and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in the Privately Insured Patient Population.

This was a large database study. The objective of this study was to compare the incidence of complications and reoperation rates between the most common surgical treatments for cervical spondylotic myelopathy (CSM): anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and posterior laminectomy and fusion (Lamifusion). CSM is a major contributor to disability and reduced quality of life worldwide. Humana insurance database was queried for CSM diagnoses between 2007 and 2016. The initial population was divided based on the surgical treatment and matched for age, sex, and Charlson Comorbidity index. Specific postoperative complications or revisions were analyzed at individual time points. Pearson χ2 analysis with Yate continuity correction was used. Lamifusion had significantly higher rates of wound infection/disruption than ACDF or ACCF (5.03%, 2.19%, 2.29%; P=0.0008, 0.002, respectively) as well as iatrogenic deformity (4.75%, 2.19%, 2.10%; P=0.0036, 0.0013). Lamifusion also had a significantly higher rate of shock and same-day transfusion than ACDF (4.75%, 2.01%, P=0.0005), circulatory complications (2.01%, <1%, P=0.0183), and C5 palsy (4.84%, 1.74%, P≤0.0001). Compared with ACDF, Lamifusion had higher rates of hardware complication (3.29%, 2.01%, P=0.0468), and revision surgery (8.23% 5.85%, P=0.0395). Lamifusion had significantly lower rates of dysphagia than either ACDF (3.93% vs. 6.58%, P=0.0089) or ACCF (3.93% vs. 8.59%, P<0.0001). When comparing ACCF to ACDF, ACCF had significantly higher rates of circulatory complications (2.38%, <1%, P=0.0053), shock/same-day transfusion (3.2%, 2.0%, P=0.59), C5 palsy (3.47%, 1.74%, P=0.0108), and revision surgery (9.51%, 5.85%, P=0.0086). The data shows that posterior Lamifusion has higher overall rate of complications compared with ACDF or ACCF. Furthermore, when comparing the anterior approaches, ACDF was associated with lower rate of complication and revision. ACCF had the highest overall rate of revision surgery.

경추 척수증 수술에서 수술중 신경생리 감시 지표의 호전

To reduce the risk of neurologic deficit, intraoperative neurophysiological monitoring (IONM) is used in spine surgery. A 71-year-old male with cervical spondylotic myelopathy underwent anterior cervical corpectomy and interbody fusion. During the surgery, an increase in amplitude of motor evoked potential (MEP) was detected and a decrease in latency of somatosensory evoked potential (SSEP) followed. After surgery, he had an improvement in neurological function and subjective symptoms. Improvement of IOMN signals during surgery may indicate better prognosis in cervical spondylotic myelopathy patient.

A Clinicoradiological Assessment following Surgical Intervention in Patients of Cervical Spondylotic Myelopathy: An Institutional Experience

Abstract Introduction To critically analyze the functional and radiological improvement in patients of cervical spondylotic myelopathy (CSM) who underwent surgical decompression by an anterior or posterior approach. Materials and Methods A retrospective study was conducted in a tertiary-level Armed Forces Hospital from June 2015 to December 2019. Preoperative assessment included a thorough clinical examination and functional and radiological assessment. The surgical decompression was done by an anterior or a posterior approach with instrumented fusion. Anterior approach was taken for single or two-level involvement and posterior approach for three or more cervical levels. The pre and postoperative neurological outcome was assessed by Nurick and modified Japanese Orthopaedic Association (mJOA) score along with measurement of canal diameter and cross-sectional area. Results A total of 120 patients of CSM who underwent surgical decompression were analyzed. Both the groups were comparable and had male predominance. A total of 59 patients underwent surgical decompression by an anterior approach and the remaining 61 patients by the posterior approach. Out of the 59 patients operated by the anterior approach, 30 (50.85%) underwent anterior cervical discectomy and fusion (ACDF); remaining 29 (49.15%) underwent anterior cervical corpectomy and fusion (ACCF). In the posterior group (n = 61), 26 (42.6%) patients underwent laminoplasty and the remaining 35 (57.4%) underwent laminectomy with or without instrument fusion. Sixteen patients out of these underwent lateral mass fixation and the remaining 19 underwent laminectomy. There was functional improvement (mJOA and Nurick grade) and radiological improvement in both subgroups, which were statistically significant (p &lt; 0.0001). Conclusion A prompt surgical intervention in moderate-to-severe cases of CSM either by the anterior or the posterior approach is essential for good outcome.

Hardware failure and reoperation after hybrid anterior cervical corpectomy and discectomy for multilevel spondylotic disease: A retrospective single-institution cohort study

Background contextHybrid cervical corpectomy/ACDF (HCC-ACDF) is commonly utilized to treat multilevel cervical myelopathy; however, the incidence and mechanisms of hardware failure remain largely uncharacterized. PurposeWe report our experience with this procedure with the goal of describing and better understanding post-operative failures. MethodsThe records of 20 consecutive patients who underwent HCC-ACDF for multilevel CSM between June 2015 and December 2018 at this Hospital (blinded) were retrospectively reviewed. All patients were followed for at least 1 year after surgery and were therefore included in the study. Outcome measures include incidence of and reason for subsequent posterior cervical surgery, incidence of and reason for subsequent anterior cervical surgery, progressive symptomatic myelopathy, radiographic hardware failure, and net reduction of pre-operative kyphosis. Continuous variables are reported with means and standard deviations. Fisher’s exact test was used to compare outcomes of binary variables. Results20 patients (mean age 60) underwent anterior HCC-ACDF for 3-level CSM. Mean clinical follow up was 26 months (range: 12–56 months). Mean operative time was 205 min and mean blood loss was 105 mL. Radiographic fusion was achieved in 15 of 18 (83%) patients for whom adequate radiographic follow-up was available. HCC-ACDF resulted in an average restoration of 4 degrees of cervical lordosis (standard deviation: 7.3 degrees). One patient (5%) developed symptomatic hardware failure requiring additional surgery. One patient (5%) developed progressive myelopathy within 4 months of surgery. 2 others (10%) developed adjacent segment disease within 2 years of surgery. Three of 20 patients (15%) required subsequent posterior surgery. ConclusionsRates of hardware failure after HCC-ACDF in our series compare favorably with reports of multilevel anterior corpectomy but are higher than those reported in previous series of HCC-ACDF. No patient characteristics were significantly associated with rates of surgical failure.

Anterior Cervical Corpectomy with Cage Fixation for Cervical Spondylotic Myelopathy

Objective: This study aimed to report the clinical outcome of anterior cervical corpectomy with cage fixation in patients with cervical spondylotic myelopathy.&#x0D; Material and Methods: This observational retrospective study included 36 patients from the Neurosurgery department of Lady Ready Hospital MTI, Peshawar from 2014 January to 2015 December. After performing surgery, the patients were followed up for six months for neurological outcome and various post-operative complications such as infection, transient recurrent laryngeal palsy, screw displacement and improvements in paresthesias and gait ataxia.&#x0D; Results: Most of the patients have no post-operative complications. Seventy-five percent (n = 27) of patients reported an immediate improvement in paresthesia and fine hand movements and gait. The major reported complications were implant failure (5.55%) and recurrent laryngeal nerve transient palsy in two patients (5.55%) each.&#x0D; Conclusion: In patients with cervical spondylotic myelopathy, with anterior compression, cervical corpectomy with cage fixation is less invasive and an effective procedure with acceptable outcomes.

Fusion and subsidence rates of vertebral body sliding osteotomy: Comparison of 3 reconstructive techniques for multilevel cervical myelopathy

Vertebral body sliding osteotomy (VBSO) was previously reported as a technique to decompress spinal canal by translating the vertebral body anteriorly and is indicated for cervical myelopathy caused by spondylosis or ossification of the posterior longitudinal ligament. However, little is known about its fusion and subsidence rates. To compare the fusion and subsidence rates of VBSO, anterior cervical discectomy and fusion (ACDF), and anterior cervical corpectomy and fusion (ACCF). Retrospective cohort study PATIENT SAMPLE: One hundred sixty-eight patients who underwent VBSO, ACDF, or ACCF for the treatment of cervical myelopathy and were followed-up for more than 2 years were retrospectively reviewed. Fusion and subsidence rates, visual analog scale (VAS) scores for neck pain, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) scores were assessed. Results of the VBSO, ACDF, and ACCF groups were compared using Student's t-test and chi-square test. The fusion rate at 1-year postoperatively and the final follow-up for VBSO was 92.9% (37/42). VBSO demonstrated a higher 1-year fusion rate than ACDF (77.9% [74/95], p=0.04) and ACCF (74.2% [23/31], p=0.04). However, the fusion rate at the final follow-up did not demonstrate significant difference. The mean amount of subsidence (ACDF group, 1.5±1.2 mm; VBSO group, 1.5±1.5 mm; p=1.00) and rate of significant subsidence of > 3 mm (ACDF group, 13.7% [13/95]; VBSO group, 14.3% [6/42]; p=1.00) were similar for ACDF and VBSO. Furthermore, the mean amount of subsidence in VBSO was significantly less than that in ACCF (1.5±1.5 mm vs 2.4±2.0 mm; p=0.04). Neck pain VAS, NDI, and JOA scores were not significantly different among the groups. VBSO demonstrated faster solid union than ACDF and ACCF, although the fusion rates at the final follow-up were similar. VBSO resulted in less subsidence than ACCF at the 1-year follow-up. VBSO could be applied safely when the shape and/or location of the pathologic foci and sagittal alignment favor its application without much concern for pseudarthrosis or subsidence.

A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

BackgroundThe decision to treat multilevel cervical spondylotic myelopathy (MCSM) remains controversial. The purpose of this study is to compare the biomechanical characteristics of the intervertebral discs at the adjacent segments and internal fixation, and to provide scientific experimental evidence for surgical treatment of MCSM.MethodsAn intact C2-C7 cervical spine model was developed and validated. Four additional models were developed from the fusion model, including multilevel anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), hybrid decompression and fusion (HDF), and mACDF with cage alone (mACDF-CA). Biomechanical characteristics on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed.ResultsOf the four models, stress on the upper (C2/3) adjacent intervertebral disc was the lowest in the mACDF-CA group and highest in the ACCF group. Stress on the intervertebral discs at adjacent segments was higher for the upper C2/3 than the lower C6/7 intervertebral disc. In all models, the mACDF-CA group had the lowest stress on the intervertebral disc, while the ACCF group had the highest stress. In the three surgical models with titanium plate fixation (mACDF, ACCF, and HDF), the ACCF group had the highest stress at the titanium plate-screw interface, while the mACDF group had the lowest stress.ConclusionAmong the four anterior cervical reconstructive techniques for MCSM, mACDF-CA makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment degeneration (ASD) after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.