Anterior Cervical Corpectomy with Cage Fixation for Cervical Spondylotic Myelopathy
Keywords:Cervical Cage, Cervical fixation, Spondylotic Myelopathy, Corpectomy
Objective: This study aimed to report the clinical outcome of anterior cervical corpectomy with cage fixation in patients with cervical spondylotic myelopathy.
Material and Methods: This observational retrospective study included 36 patients from the Neurosurgery department of Lady Ready Hospital MTI, Peshawar from 2014 January to 2015 December. After performing surgery, the patients were followed up for six months for neurological outcome and various post-operative complications such as infection, transient recurrent laryngeal palsy, screw displacement and improvements in paresthesias and gait ataxia.
Results: Most of the patients have no post-operative complications. Seventy-five percent (n = 27) of patients reported an immediate improvement in paresthesia and fine hand movements and gait. The major reported complications were implant failure (5.55%) and recurrent laryngeal nerve transient palsy in two patients (5.55%) each.
Conclusion: In patients with cervical spondylotic myelopathy, with anterior compression, cervical corpectomy with cage fixation is less invasive and an effective procedure with acceptable outcomes.
2. Raj-D-Rao BLC, Albert TJ, Bono CM, Marawar SV, Poelstra KA, Eck JC. Degenerative cervical spondylosis: clinical syndromes, pathogenesis, and management,” The Journal of Bone and Joint Surgery, 2007; 89 (6): 1360–78.
3. Akiyama-HGaM. What is the optimal method of managing a patient with cervical myelopathy? In: Wright JG, editor. Evidence based orthopedics. Toronto, Ontario, Canada: Saunders; 2008.
4. Yalamanchili MJV, Chaudhary SB. Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach. Advances in Orthopedics. 2012, Article ID 783762, 2012.
5. Symon L, Lavender P. The surgical treatment of cervical spondylotic myelopathy. Neurology, 1967; 17 (2): 117.
6. Sampath P, Bendebba M, Davis JD, Ducker TB. Outcome of patients treated for cervical myelopathy: a prospective, multicenter study with independent clinical review. Spine, 2000; 25 (6): 670-6.
7. Kadanka ZMM, Bednarik J, Smrcka V, Chaloupa R, Dusek L. Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically. European Journal of Neurology, 2005; 12: 55-63.
8. Ghogawala ZCJ, Benzel EC. Ventral versus dorsal decompression for cervical spondylotic myelopathy: surgeons’ assessment of eligibility for randomization in a proposed randomized controlled trial: results of a survey of the Cervical Spine Research Society. Spine, 2007; 32: 429–36.
9. Kawakami MTT, Lwasaki H. A comparative study of surgical approaches for cervical compressive myelopathy. Clin Orthop Relat Res. 2000; 381: 129-36.
10. Hillard VHAR. Surgical management of cervical myelopathy: indications and techniques for multilevel cervical discectomy. Spine J. 2006; 6 (6): S242–S51.
11. Shamji MFCC, Pietrobon R. Impact of surgical approach on complications and resource utilization of cervical spine fusion: a nationwide perspective to the surgical treatment of diffuse cervical spondylosis. Spine J. 2009; 9: 31-8.
12. Burkhardt JKMA, Marbacher S, Dolp PA, Fekete TF, Jeszenszky D, Porchet F. A comparative effectiveness study of patient-rated and radiographic outcome after 2 types of decompression with fusion for spondylotic myelopathy: anterior cervical discectomy versus corpectomy. Neurosurg Focus, 2013; 35 (1): E4.
13. Guan LHY, Yang JC, Zhou LJ, Chen XL. Anterior
cervical discectomy and fusion may be more effective than anterior cervical corpectomy and fusion for the treatment of cervical spondylotic myelopathy. BMC Musculoskelet Disord. 2015; 16: 29.
14. Khalid M, Farooq U, Ahmed E, Khaleeq S, Khaleeq-uz-Zaman. Surgical Outcome of Corpectomy, Bone Grafting and Caspar Plating in Non-Traumatic Cervical Spine Disease. J Postgrad Med Ins. 2017; 31 (3): 304-9.
15. Chibbaro LBS, Carnesecchi S, Marsella M, Pulera F, Serino D, Gagliardi R. Anterior cervical corpectomy for cervical spondylotic myelopathy: Experience and surgical results in a series of 70 consecutive patients. Journal of Clinical Neuroscience, 2006; 13: 233–8.
16. Northover J, Wild J, Braybrooke J, Blanco J. The epidemiology of cervical spondylotic myelopathy. Skeletal Radiology, 2012; 41 (12): 1543-6.
17. Lin Q, Zhou X, Wang X, Cao P, Tsai N, Yuan W. A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. European Spine Journal, 2012; 21 (3): 474-81.
18. Oh MC, Zhang HY, Park JY, Kim KS. Two-level anterior cervical discectomy versus one-level corpectomy in cervical spondylotic myelopathy. Spine, 2009; 34 (7): 692-6.
19. Huang ZY, Wu AM, Li QL, Lei T, Wang KY, Xu HZ,
et al. Comparison of two anterior fusion methods in two-level cervical spondylosis myelopathy: a meta-analysis. BMJ Open, 2014; 4 (7): e004581.
20. Han YC, Liu ZQ, Wang SJ, Li LJ, Tan J. Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy? A systemic review and meta-analysis. PLoS One, 2014; 9 (1): e87191.
21. Fernyhough JC, White JI, LaRocca H. Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine, 1991; 16: S561–S564.
22. Lin Q, Zhou X, Wang X. A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J. 2012; 21 (3): 474–481.
23. Park Y, Maeda T, Cho W, Riew KD. Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification. Spine J. 2010; 10 (3): 193-9.
Doi: 10.1016/j.spinee.2009.09.006. Epub 2009 Oct 21. PMID: 19850532.
24. Lau D, Chou D, Mummaneni PV. Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes. J Neurosurg Spine, 2015; 23 (3): 280-9.
Doi: 10.3171/2014.12.SPINE14545. Epub 2015 Jun 19. PMID: 26091438.
25. Hessler C, Boysen K, Regelsberger J, Vettorazzi E, Winkler D, Westphal M. Patient satisfaction after anterior cervical discectomy and fusion is primarily driven by relieving pain. Clin J Pain, 2012; 28 (5): 398–403.
26. Burkhardt JK, Mannion AF, Marbacher S, Dolp PA, Fekete TF, Jeszenszky D, et al. A comparative effectiveness study of patient-rated and radiographic outcome after 2 types of decompression with fusion for spondylotic myelopathy: anterior cervical discectomy versus corpectomy. Neurosurg Focus, 2013; 35 (1): E4. Doi: 10.3171/2013.3.FOCUS1396. PMID: 23815249.