Reconstructive techniques study after anterior decompression of multilevel cervical spondylotic myelopathy

Abstract

Study design: Retrospectively compared 2 reconstructive techniques after the anterior decompression of multilevel cervical spondylotic myelopathy.

Objective: To clinically compare the biomechanical stability and neurologic results of 2 reconstructive techniques after the anterior decompression of multilevel cervical spondylotic myelopathy retrospectively.

Summary of background data: Previous studies comparing different reconstruction techniques after the anterior decompression of multilevel cervical spondylotic myelopathy have yielded mixed results. Some studies have reported a high incidence of graft-plate extrusion when 2 or more corpectomies are performed and reconstructed with a long segmental anterior plate fixation that spans the strut graft without supplemental posterior cervical fixation, a standalone cage and segmental plate fixation after combination 1 level discectomy and 1 level corpectomy used to treat multilevel cervical spondylotic myelopathy were reported have no evidence of late-onset instrumentation-related failure, although 2 techniques have never been directly compared in a consecutive series of patients clinically.

Methods: A retrospective study of 59 patients with multilevel (3 levels) cervical spondylotic myelopathy treated with 1 of 2 anterior decompression and reconstruction methods were compared. Copectomy method (39 patients) is 2-level corpectomies and long segment end-construct plate fixation; hybrid method (20 patients) is standalone cage and segmental plate fixation after 1-level discectomy combined with 1-level corpectomy.

Results: The follow-up (mean18 mo) results show both methods had similar, satisfactory recovery of neurologic function (P>0.05). There were 7 cases of graft/plate migrations or dislodgments (17.9%) and 4 of these required revision surgery among 39 patients with corpectomy method, as compared with no graft/implant-related complications or nonunion among 20 patients with hybrid method (P<0.001).

Conclusions: This study clearly demonstrates that, adequate decompression can be achieved for the multilevel cervical spondylotic myelopathy with both methods, and the hybrid method offers better biomechanical stability and fusion results than the corpectomy method, and obviates the need for staged circumferential procedures.