Cervical spondylotic myelopathy treated with corpectomy: technique and results in 44 patients

Abstract

Forty-four patients with cervical spondylotic myelopathy who underwent a ventral surgical approach were evaluated with respect to the results of surgery. The neurological status of the patients was categorized according to the modified Japanese Orthopedic Association scale (0-18). Three patients had a functional score of 8, one patient 9, five patients 10, five patients 11, seven patients 12, seven patients 13, seven patients 14, and nine patients had a functional score of 15, preoperatively. Twenty-three patients underwent a one-level corpectomy, 15 patients a two-level corpectomy, and six patients underwent a three-level corpectomy. Forty-one (93.1%) of the 44 patients underwent ventral cervical plate fixation. Complications among the 44 patients included graft- and instrumentation-related complications in seven cases, iliac crest donor-site infection in three cases, and respiratory complications in three cases. The follow-up periods ranged between 7 and 60 months (mean 42.3 months). Overall, the fusion rate was 97.72%. Three patients showed no functional change (6.8%), two patients were worse (4.5%), and 39 patients (88.6%) showed functional improvement in their score between +1 and +6 points (mean 2.16 points). There was no statistically significant difference in the functional improvement score in patients younger or older than 60 years old. The mean improvement in the functional score was found to be +2.857 +/- 1.352, +2.400 +/- 1.454, and +0.5000 +/- 1.871 following one-level corpectomy, two-level, and three-level corpectomies, respectively. There were statistically significant differences in the neurological improvement observed between patients with one-level corpectomy and three-level corpectomy (p < 0.01), as well as between those with two-level and three-level corpectomy (p < 0.05). There was no statistically significant difference in the neurological outcome between patients with one-level and two-level corpectomy (p > 0.05). The results of this study demonstrate a high rate of solid bone fusion and a high rate of functional (neurological) improvement. Five patients underwent reoperation, predominantly for instrumentation failure. The use of instrumentation dictates careful consideration of the risk/benefit ratio associated with its use in each case.