Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy

Abstract

Purpose: Anterior approach was extensively used in surgical treatment of multilevel cervical spondylotic myelopathy. Following anterior decompression, many different reconstructive techniques (multilevel ACDF, hybrid construct and long corpectomy) all had satisfied outcomes. However, there are few studies focusing on the comparison of these three reconstructed techniques. The aim of this retrospective study was to analyze the complications of these three different methods.

Methods: This study retrospectively reviewed the complications in 286 consecutive patients with multilevel CSM who underwent anterior cervical surgery from 2005 to 2010. This case series had 166 men and 120 women whose mean age at surgery was 53.8 years (range from 33 to 74 years). Radiographic evaluation was taken the day after surgery, and the flexion-extension X-rays were added 3, 12 and 24 months postoperatively to evaluate the fusion condition. Preoperative versus postoperative neurologic function and clinical outcome were evaluated using scoring systems such as the Japanese Orthopedic Association (JOA score), Neck Disability Index (NDI score) and 36-Item Short-Form Health Survey (SF-36 score).

Results: There were no significant differences in JOA scores, NDI scores and SF-36 scores of the pairwise comparison among the three groups. The complications in our series included graft migration, collapse or displacement, hoarseness, dysphagia, C5 palsy, cerebral fluid leakage and wound infection. Sixty-one patients developed complications after surgery and the rate of complication was 21.33 %. Patients in the long corpectomy group had the highest rate of complications; the other two groups had a much lower rate of complications by the latest follow-up. The patients in the multilevel ACDF group had the highest fusion rate by the last follow-up. Patients who had C2-3 and C3-4 segments involved had a higher rate of postoperative hoarseness and dysphagia.

Conclusions: Most of the complications of the three reconstructive techniques subsided gradually after conservative treatment; none of them needed revision surgery. The multilevel ACDF approach has the lowest rate of non-union, but a slightly higher morbidity of the laryngeal nerve-related complication if proximal segments were involved. The long corpectomy approach should be selected prudently because of the high rate of complication.

Fig. 1

Lateral postoperative radiography of the three reconstructive methods following anterior approach of MCSM: multilevel ACDF (a), hybrid construct (one corpectomy plus one ACDF, b), and long corpectomy (c)

Fig. 2

Bar graph of representing the rate of complications in multilevel ACDF group, hybrid construct group and long corpectomy group

Fig. 3

A 44-year-old male patient complained of difficulty of ambulation and numbness of lower limbs for 3 months. Preoperative cervical X-ray film (a) and MRI scan (b) showed C3/4, C4/5 and C5/6 disc herniation and high signal intensity at C5/6 level on T2-weighted image. He underwent a C3/4 discectomy and C5 corpectomy following anterior decompression. Postoperative radiography the day after surgery demonstrates a good position of implant (c). At 2-year follow-up, the lateral cervical plain film showed screw breakage. No revision surgery was required due to absence of severe clinical symptoms

Fig. 4

A 55-year-old female patients complained of numbness of both hands and difficulty of ambulation for 10 years. Preoperative cervical X-ray film (a) and MRI scan (b) showed C3/4, C4/5 and C5/6 disc herniation combined with high signal intensity at C5/6 level on T2-weighted image. Two corpectomies of C4 and C5 were preformed following anterior decompression. Postoperative radiography the day after surgery showed a satisfactory position of instrumentation (c). Significant migration of titanium mesh was observed at 6-month follow-up (d). Because no severe clinical symptoms manifested, further follow-up is needed