Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy

Restricted access

✓ This study was conducted to determine the safety and efficacy of multilevel anterior cervical corpectomy and stabilization using fibular allograft in patients with cervical myelopathy. Thirty-six patients underwent this procedure for cervical myelopathy caused by spondylosis (20 patients), ossified posterior longitudinal ligament (four patients), trauma (one patient), or a combination of lesions (11 patients). The mean age (± standard deviation) of the patients was 58 ± 10 years and 30 of the patients were men. The mean duration of symptoms before surgery was 30 ± 6 months and 11 patients had undergone previous surgery. Prior to surgery, the mean Nurick grade of the myelopathy was 3.1 ± 1.4. Seventeen patients also had cervicobrachial pain. Four vertebrae were removed in six patients, three in 19, and two in 11 patients. Instrumentation was used in 15 cases. The operative mortality rate was 3% (one patient) and two patients died 2 months postoperatively. Postoperative complications included early graft displacement requiring reoperation (three patients), transient dysphagia (two patients), cerebrospinal fluid leak treated by lumbar drainage (three patients), myocardial infarction (two patients), and late graft fracture (one patient). One patient developed transient worsening of myelopathy and three developed new, temporary radiculopathies. All patients achieved stable bone union and the mean Nurick grade at an average of 31 6 20 months (range 0–79 months) postoperatively was 2.4 ± 1.6 (p < 0.05, t-test). Cervicobrachial pain improved in 10 (59%) of the 17 patients who had preoperative pain and myelopathy improved at least one grade in 17 patients (47%; p < 0.05). Twenty-six surviving patients (72%) were followed for more than 24 months and stable, osseous union occurred in 97%. These results show that extensive, multilevel anterior decompression and stabilization using fibular allograft can be achieved with a perioperative mortality and major morbidity rate of 22% and with significant improvement in pain and myelopathy.

Article Information

Address reprint requests to: R. Loch Macdonald, M.D., Ph.D., Section of Neurosurgery, MC3026, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, Illinois 60637.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Left: Lateral radiograph obtained immediately postoperatively, showing a fibular strut graft extending from C-2 to C-6. Center: Postoperative radiograph, obtained 2 years later, displaying complete incorporation of the graft with ossification along the anterior aspects of the vertebral bodies. Right: A CT myelogram, obtained because the patient developed increasing pyramidal tract dysfunction, showing that there is adequate decompression of the cord. The patient was found to have lacunar cerebral infarctions.

  • View in gallery

    Magnetic resonance image obtained 6 months after a three-level corpectomy of C4–6 and stabilization using fibula allograft in a 41-year-old patient with multilevel cervical spondylosis and two traumatic cervical spine injuries. The MR image, obtained to follow the posttraumatic syrinx, shows an adequate decompression with bulging of the thecal sac into the decompression site.

  • View in gallery

    Left: Magnetic resonance image obtained in a 53-year-old patient presenting with progressive numb, tingling hands. It was not recognized that the low signal intensity posterior to the C-3 and C-4 vertebral bodies represented OPLL. Center: A CT scan showing the OPLL. The scan was obtained after an anterior cervical discectomy and fusion at C4–5 failed to relieve her symptoms. The patient underwent anterior corpectomies at C3–5 and the inferior part of the C-2, followed by a fibula strut graft and instrumentation. At the time this procedure was performed, long cervical reconstruction plates were unavailable. Accordingly, a buttress plate was used at the caudal end of the construct. Right: Immediate postoperative radiograph showing the instrumentation. The patient made substantial improvement and the graft progressed to osseous union.

References

  • 1.

    Bernard TN JrWhitecloud TS III: Cervical spondylotic myelopathy and myeloradiculopathy. Anterior decompression and stabilization with autogenous fibula strut graft. Clin Orthop 221:1491601987Bernard TN Jr Whitecloud TS III: Cervical spondylotic myelopathy and myeloradiculopathy. Anterior decompression and stabilization with autogenous fibula strut graft. Clin Orthop 221:149–160 1987

    • Search Google Scholar
    • Export Citation
  • 2.

    Boni MCherubino PDenaro Vet al: Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases. Spine 9:3583621984Boni M Cherubino P Denaro V et al: Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases. Spine 9:358–362 1984

    • Search Google Scholar
    • Export Citation
  • 3.

    Brown JAHavel PEbraheim Net al: Cervical stabilization by plate and bone fusion. Spine 13:2362401988Brown JA Havel P Ebraheim N et al: Cervical stabilization by plate and bone fusion. Spine 13:236–240 1988

    • Search Google Scholar
    • Export Citation
  • 4.

    Brown MDMalinin TIDavis PB: A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop 119:2312361976Brown MD Malinin TI Davis PB: A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop 119:231–236 1976

    • Search Google Scholar
    • Export Citation
  • 5.

    Cattell HSClark GL Jr: Cervical kyphosis and instability following multiple laminectomies in children. J Bone Joint Surg (Am) 49:7137201967Cattell HS Clark GL Jr: Cervical kyphosis and instability following multiple laminectomies in children. J Bone Joint Surg (Am) 49:713–720 1967

    • Search Google Scholar
    • Export Citation
  • 6.

    Fernyhough JCWhite JILaRocca H: Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 16:S561S5641991Fernyhough JC White JI LaRocca H: Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 16:S561–S564 1991

    • Search Google Scholar
    • Export Citation
  • 7.

    Gore DRSepic SB: Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine 9:6676711984Gore DR Sepic SB: Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine 9:667–671 1984

    • Search Google Scholar
    • Export Citation
  • 8.

    Goto SMochizuki MKita Tet al: Anterior surgery in four consecutive technical phases for cervical spondylotic myelopathy. Spine 18:196819731993Goto S Mochizuki M Kita T et al: Anterior surgery in four consecutive technical phases for cervical spondylotic myelopathy. Spine 18:1968–1973 1993

    • Search Google Scholar
    • Export Citation
  • 9.

    Hanai KFujiyoshi FKamei K: Subtotal vertebrectomy and spinal fusion for cervical spondylotic myelopathy. Spine 11:3103151986Hanai K Fujiyoshi F Kamei K: Subtotal vertebrectomy and spinal fusion for cervical spondylotic myelopathy. Spine 11:310–315 1986

    • Search Google Scholar
    • Export Citation
  • 10.

    Hanai KInouye YKawai Ket al: Anterior decompression for myelopathy resulting from ossification of the posterior longitudinal ligament. J Bone Joint Surg (Br) 64:5615641982Hanai K Inouye Y Kawai K et al: Anterior decompression for myelopathy resulting from ossification of the posterior longitudinal ligament. J Bone Joint Surg (Br) 64:561–564 1982

    • Search Google Scholar
    • Export Citation
  • 11.

    Herman JMSonntag VKH: Cervical corpectomy and plate fixation for postlaminectomy kyphosis. J Neurosurg 80:9639701994Herman JM Sonntag VKH: Cervical corpectomy and plate fixation for postlaminectomy kyphosis. J Neurosurg 80:963–970 1994

    • Search Google Scholar
    • Export Citation
  • 12.

    Hukuda SMochizuki TOgata Met al: Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures. J Bone Joint Surg (Br) 67:6096151985Hukuda S Mochizuki T Ogata M et al: Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures. J Bone Joint Surg (Br) 67:609–615 1985

    • Search Google Scholar
    • Export Citation
  • 13.

    Kaneda KKurakami CMinami A: Free vascularized fibular strut graft in the treatment of kyphosis. Spine 13:127312771988Kaneda K Kurakami C Minami A: Free vascularized fibular strut graft in the treatment of kyphosis. Spine 13:1273–1277 1988

    • Search Google Scholar
    • Export Citation
  • 14.

    Kojima TWaga SKubo Yet al: Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament. Neurosurgery 24:8648721989Kojima T Waga S Kubo Y et al: Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament. Neurosurgery 24:864–872 1989

    • Search Google Scholar
    • Export Citation
  • 15.

    Kurz LTGarfin SRBooth RE: Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 14:132413311989Kurz LT Garfin SR Booth RE: Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 14:1324–1331 1989

    • Search Google Scholar
    • Export Citation
  • 16.

    Lunsford LDBissonette DJZorub DS: Anterior surgery for cervical disc disease. Part 2: treatment of cervical spondylotic myelopathy in 32 cases. J Neurosurg 53:12191980Lunsford LD Bissonette DJ Zorub DS: Anterior surgery for cervical disc disease. Part 2: treatment of cervical spondylotic myelopathy in 32 cases. J Neurosurg 53:12–19 1980

    • Search Google Scholar
    • Export Citation
  • 17.

    Naito MKurose SOyama Met al: Anterior cervical fusion with the Caspar instrumentation system. Int Orthop 17:73761993Naito M Kurose S Oyama M et al: Anterior cervical fusion with the Caspar instrumentation system. Int Orthop 17:73–76 1993

    • Search Google Scholar
    • Export Citation
  • 18.

    Nurick S: The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:871001972Nurick S: The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100 1972

    • Search Google Scholar
    • Export Citation
  • 19.

    Okada KShirasaki NHayashi Het al: Treatment of cervical spondylotic myelopathy by enlargement of the spinal canal anteriorly, followed by arthrodesis. J Bone Joint Surg (Am) 73:3523641991Okada K Shirasaki N Hayashi H et al: Treatment of cervical spondylotic myelopathy by enlargement of the spinal canal anteriorly followed by arthrodesis. J Bone Joint Surg (Am) 73:352–364 1991

    • Search Google Scholar
    • Export Citation
  • 20.

    Saunders RLBernini PMShirreffs TGet al: Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 74:1631701991Saunders RL Bernini PM Shirreffs TG et al: Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 74:163–170 1991

    • Search Google Scholar
    • Export Citation
  • 21.

    Schneider JRBright RW: Anterior cervical fusion using preserved bone allografts. Transplant Proc 8 (Suppl 1):73761976Schneider JR Bright RW: Anterior cervical fusion using preserved bone allografts. Transplant Proc 8 (Suppl 1):73–76 1976

    • Search Google Scholar
    • Export Citation
  • 22.

    Seifert VStolke D: Multisegmental cervical spondylosis: treatment by spondylectomy, microsurgical decompression, and osteosynthesis. Neurosurgery 29:4985031991Seifert V Stolke D: Multisegmental cervical spondylosis: treatment by spondylectomy microsurgical decompression and osteosynthesis. Neurosurgery 29:498–503 1991

    • Search Google Scholar
    • Export Citation
  • 23.

    Tippets RHApfelbaum RI: Anterior cervical fusion with the Caspar instrumentation system. Neurosurgery 22:100810131988Tippets RH Apfelbaum RI: Anterior cervical fusion with the Caspar instrumentation system. Neurosurgery 22:1008–1013 1988

    • Search Google Scholar
    • Export Citation
  • 24.

    Whitecloud TS III: Anterior surgery for cervical spondylotic myelopathy. Smith-Robinson, Cloward, and vertebrectomy. Spine 13:8618631988Whitecloud TS III: Anterior surgery for cervical spondylotic myelopathy. Smith-Robinson Cloward and vertebrectomy. Spine 13:861–863 1988

    • Search Google Scholar
    • Export Citation
  • 25.

    Whitecloud TS IIILaRocca H: Fibular strut graft in reconstructive surgery of the cervical spine. Spine 1:33431976Whitecloud TS III LaRocca H: Fibular strut graft in reconstructive surgery of the cervical spine. Spine 1:33–43 1976

    • Search Google Scholar
    • Export Citation
  • 26.

    Yonenobu KFuji TOno Ket al: Choice of surgical treatment for multisegmental cervical spondylotic myelopathy. Spine 10:7107161985Yonenobu K Fuji T Ono K et al: Choice of surgical treatment for multisegmental cervical spondylotic myelopathy. Spine 10:710–716 1985

    • Search Google Scholar
    • Export Citation
  • 27.

    Young WFRosenwasser RH: An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy. Spine 18:112311241993Young WF Rosenwasser RH: An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy. Spine 18:1123–1124 1993

    • Search Google Scholar
    • Export Citation
  • 28.

    Zdeblick TABohlman HH: Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting. J Bone Joint Surg (Am) 71:1701821989Zdeblick TA Bohlman HH: Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting. J Bone Joint Surg (Am) 71:170–182 1989

    • Search Google Scholar
    • Export Citation
  • 29.

    Zdeblick TADucker TB: The use of freeze-dried allograft bone for anterior cervical fusions. Spine 16:7267291991Zdeblick TA Ducker TB: The use of freeze-dried allograft bone for anterior cervical fusions. Spine 16:726–729 1991

    • Search Google Scholar
    • Export Citation

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 261 261 12
Full Text Views 208 208 0
PDF Downloads 108 108 0
EPUB Downloads 0 0 0

PubMed

Google Scholar