Article
Anterior-posterior cervical intrumentation – the need and benefits in multilevel corpectomy and cervico-thoracic pathology
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Published: | June 9, 2017 |
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Objective: Postoperative stability of the cervical spine is affected by the increasing number of decompressed levels and also depending on the underlying disease. Considering the stability alone the anterior-posterior instrumentation seems to be the best choice. However, in multimorbid elderly patients the combined approach could be disproportionately risky. Therefore it is a balancing act between the extent of surgery for postoperative stability and patient safety. We report on our experience in anterior-posterior cervical instrumentation in complex spine reconstruction and the postoperative results.
Methods: We retrospectively identified 38 patients aged between 38 and 85 years (64±10 years, 20 female vs. 17 male) over the last six years. The inclusion criteria were anterior-posterior instrumentation either including cervico-thoracic junction or multilevel (≥2) cervical corpectomy. Reasons for surgery were pathologic and traumatic fractures, advanced degeneration or purulent diseases of the cervical spine. All patients received postoperative computed tomography and follow- ups (8±7 months, range 1–28 months).
Results: Patients were assigned into two groups, the larger group 1 (87%, n=33) received anterior-posterior cervical instrumentation in a one-stage approach, including 2 patients (5%) who were initially scheduled for unilateral instrumentation (anterior or dorsal) – in which early instability of the instrumentation during current hospital stay forced to immediate conversion to the combined (anterior and dorsal) approach. Group 2 (13%, n=5) in retrospect was treated in a two-stage procedure. Initial unilateral instrumentation led to instability in the course after a mean time of 11 months (range 1–28 months). None of the group 1 patients showed secondary instrumentation failure after the combined one-stage approach.
No patient died after the treatment and none showed lasting deterioration in the neurological outcome. Eight patients were unchanged (21%) and thirty patients improved (79%) in terms of sensorimotor function, pain level and / or spasticity.
Seven patients of group 1 (21%) developed complications like wound healing disturbances (6%, n=2), pleura effusion, urinary tract infection, Horner’s syndrome, paralysis of the recurrent nerve and pneumonia (each 3% / n=1). Three patients (60%) of group 2 showed wound healing disturbances (40%, n=2) and pneumonia (20%).
Conclusion: Considering the lower morbidity and missing instability in the course, the anterior-posterior cervical instrumentation in multilevel corpectomy and cervico-thoracic junction pathology seems to be unrivaled at the moment – especially in regard of missing adequate alternatives.