gms | German Medical Science

Objective: Microsurgical corpectomy and additional fusion with a cervical plate is a well-established procedure to address ventral pathologies of the cervical spine. It is widely used for treatment of degeneration and instability, ossification of the posterior longitudinal ligament, trauma, tumor or infection. The approach shows a calculable perioperative complication rate and a good clinical outcome. A 1-level corpectomy bears a high fusion rate, whereas a multi-level corpectomy (≥3 levels) leads to a severe risk of cervical instability and needs additional posterior fusion. The proceeding in patients, who need a 2-level corpectomy, is still discussed controversially and the data available is not satisfactory. The authors present a retrospective study to investigate, whether patients, who received 2-level corpectomy, need additional dorsal instrumentation to guarantee a long-term stability.

Method: 20 patients, who received 2-level cervical corpectomy in our department from 2006-2012, were retrospectively investigated. CT, MRI, Myelographie, x-rays as well as outcome scores (VAS, ODI for neck pain, mJOAS, SF-36) were collected from the outpatient department and hospital stay. Patients were assigned into two groups. The first group included patients who received only anterior corpectomy with implantation of a cervical plate (anterior approach group, AAG, N=12). In the second group patients primarily received a combined approach with additional posterior fusion (combined approach group, CAG, N=10). Reoperations and outcome of both groups were compared.

Results: 12 patients received surgery suffering from degenerative spine disease, 4 from tumor disease and 4 from infection including spondylodiscitis and osteomyelitis. The mean follow-up time was 39 months and all patients received control x-rays of the cervical spine. Both groups improved after surgery concerning neck pain, neurology- and pain-related disability. However in the AAG 4 patients (33%) developed clinical deterioration and needed additional posterior fusion because of an instability of the cervical construction.

Conclusions: 2-level corpectomy is a save and effective surgery with a good clinical outcome in patients with degenerative, tumor or infectious disease. However isolated decompression from anterior in addition with a cervical plate bears a significant risk of future instability, which makes another surgery necessary. Therefore an additional posterior fusion should be considered in patients with good prognosis.