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. 2019 Jun;42(2):511-518.
doi: 10.1007/s10143-018-0993-6. Epub 2018 Jun 18.

Two-level cervical corpectomy-long-term follow-up reveals the high rate of material failure in patients, who received an anterior approach only

Simon Heinrich Bayerl  1 , Florian Pöhlmann  1 , Tobias Finger  1 , Vincent Prinz  1 , Peter Vajkoczy  2
Affiliations

Two-level cervical corpectomy-long-term follow-up reveals the high rate of material failure in patients, who received an anterior approach only

Simon Heinrich Bayerl et al. Neurosurg Rev. 2019 Jun.

Abstract

In contrast to a one-level cervical corpectomy, a multilevel corpectomy without posterior fusion is accompanied by a high material failure rate. So far, the adequate surgical technique for patients, who receive a two-level corpectomy, remains to be elucidated. The aim of this study was to determine the long-term clinical outcome of patients with cervical myelopathy, who underwent a two-level corpectomy. Outcome parameters of 21 patients, who received a two-level cervical corpectomy, were retrospectively analyzed concerning reoperations and outcome scores (VAS, Neck Disability Index (NDI), Nurick scale, modified Japanese Orthopaedic Association score (mJOAS), Short Form 36-item Health Survey Questionnaire (SF-36)). The failure rate was determined using postoperative radiographs. The choice over the surgical procedures was exercised by every surgeon individually. Therefore, a distinction between two groups was possible: (1) anterior group (ANT group) with a two-level corpectomy and a cervical plate, (2) anterior/posterior group (A/P group) with two-level corpectomy, cervical plate, and additional posterior fusion. Both groups benefitted from surgery concerning pain, disability, and myelopathy. While all patients of the A/P group showed no postoperative instability, one third of the patients of the ANT group exhibited instability and clinical deterioration. Thus, a revision surgery with secondary posterior fusion was needed. Furthermore, the ANT group had worse myelopathy scores (mJOASANT group = 13.5 ± 2.5, mJOASA/P group = 15.7 ± 2.2). Patients with myelopathy, who receive a two-level cervical corpectomy, benefitted from surgical decompression. However, patients with a sole anterior approach demonstrated a very high rate of instability (33%) and clinical deterioration in a long-term follow-up. Therefore, we recommend to routinely perform an additional posterior fusion after two-level cervical corpectomy.

Keywords: Cervical instability; Cervical myelopathy; Neck pain; Posterior fusion; Two-level cervical corpectomy.

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