Carla DORIA, Giulia Raffaella MOSELE, Massimo BALSANO, Gianluca MAESTRETTİ, Gianfilippo CAGGIARI

Anterior decompression and plate fixation in treatment of cervical myelopathy: A multicentric retrospective review

Objectives: The aim of this study was to evaluate the results on anterior decompression and fusion with titanium mesh or expanding cage and plate fixation in patients with cervical myelopathy. Methods: We conducted a retrospective multicentric review of 114 patients, 75 males and 39 females, with cervical myelopathy who underwent surgical treatment between July 2009 to December 2011. All surgeries were performed via a ventral approach. Based on the type of surgery the patients received, they were divided into 3 groups: group 1 consisted of 49 patients who received multilevel corpectomies and fusion with strut iliac bone graft and plates; group 2 consisted of 26 patients who received multilevel corpectomies and fusion with titanium expanding cage and plating; group 3 consisted of 39 patients who received multilevel corpectomies and fusion using titanium mesh with autologous bone graft and anterior plating. Results: Decompression of the cervical spinal cord and grafting with plate fixation via a ventral approach demonstrated a high rate of improvement in neurological function with minimal complications. Fusion was documented radiologically in all cases. Eighty-three patients experienced a partial improvement and 41 had a complete recovery according to Nurick's myelopathy grading. Sixty-two patients were ranked as excellent, 48 as good, 4 as fair; unsatisfactory outcome was related to donor site complications.

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28. Tasiou A, Giannis T, Brotis AG, et al. Anterior cervical spine surgery-associated complications in a retrospective case-control study. J Spine Surg. 2017 Sep;3(3): 444e459.

27. Joaquim AF, Murar J, Savage JW, Patel AA. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J. 2014 Sep 1;14(9):2246e2260.

26. Malloy KM, Hilibrand AS. Autograft versus allograft in degenerative cervical disease. Clin Orthop Relat Res. 2002 Jan;(394):27e38.

25. Sugawara T. Neurologic complications in managing degenerative cervical myelopathy: pathogenesis, prevention, and management. Neurosurg Clin N Am. 2018 Jan;29(1):129e137.

24. Johnston FG, Crockard HA. One-stage internal fixation and anterior fusion in complex cervical spinal disorders. J Neurosurg. 1995 Feb;82(2):234e238.

23. Bartels RH, Donk RD, Feuth T. Subsidence of stand-alone cervical carbon fiber cages. Neurosurgery. 2006 Mar;58(3):502e508.

22. Schroder€ J, Herbort M, Rustemeyer P, Vieth V, Wassmann H. Mechanical response of cervical vertebral endplates to axial loading. Zentralbl Neurochir. 2006 Nov;67(4):188e192.

21. Manunta ML, Careddu GM, Masala G, et al. Lumbar interbody expanding cage. A preliminary study on an animal model. Vet Comp Orthop Traumatol. 2008;21(4):382e384.

20. Muzevic D, Splavski B, Boop FA, Arnautovic KI. Anterior cervical discectomy with instrumented allograft fusion: lordosis restoration and comparison of functional outcomes among patients of different age groups. World Neurosurg. 2018 Jan;109:e233ee243.

19. Silber JS, Anderson DG, Daffner SD, et al. Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2003 Jan 15;28(2):134e139.

18. McCullen GM, Garfin SR. Spine update: cervical spine internal fixation using screw and screw-plate constructs. Spine (Phila Pa 1976). 2000 Mar 1;25(5): 643e652.

17. Boni M, Cherubino P, Denaro V, Benazzo F. Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases. Spine (Phila Pa 1976). 1984 May-Jun;9(4):358e362.

16. Thakar S, Christopher S, Rajshekhar V. Quality of life assessment after central corpectomy for cervical spondylotic myelopathy: comparative evaluation of the 36-Item Short Form Health Survey and the World Health Organization Quality of Life-Bref. J Neurosurg Spine. 2009 Oct;11(4):402e412.

15. Miscusi M, Polli FM, Forcato S, et al. Comparison of minimally invasive surgery with standard open surgery for vertebral thoracic metastases causing acute myelopathy in patients with short- or mid-term life expectancy: surgical technique and early clinical results. J Neurosurg Spine. 2015 May;22(5): 518e525.

14. Basques BA, Hijji FY, Khechen B, et al. Gender differences for anterior cervical fusion: complications and length of stay. Spine (Phila Pa 1976). 2017 Dec 5.

13. Wei-bing X, Wun-Jer S, Gang L, Yue Z, Ming-xi J, Lian-shun J. Reconstructive techniques study after anterior decompression of multilevel cervical spondy-lotic myelopathy. J Spinal Disord Tech. 2009 Oct;22(7):511e515.

12. Shamji MF, Massicotte EM, Traynelis VC, Norvell DC, Hermsmeyer JT, Fehlings MG. Comparison of anterior surgical options for the treatment of multilevel cervical spondylotic myelopathy: a systematic review. Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S195eS209.

11. Zdeblick TA, Ducker TB. The use of freeze-dried allograft bone for anterior cervical fusions. Spine (Phila Pa 1976). 1991 Jul;16(7):726e729.

10. Young 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 (Phila Pa 1976). 1993 Jul;18(9):1123e1124.

9. Dorai Z, Morgan H, Coimbra C. Titanium cage reconstruction after cervical corpectomy. J Neurosurg. 2003 Jul;99(1 Suppl):3e7.

8. Arts MP, Peul WC. Vertebral body replacement systems with expandable cages in the treatment of various spinal pathologies: a prospectively followed case series of 60 patients. Neurosurgery. 2008 Sep;63(3):537e544.

7. Samandouras G, Shafafy M, Hamlyn PJ. A new anterior cervical instrumentation system combining an intradiscal cage with an integrated plate: an early technical report. Spine (Phila Pa 1976). 2001 May 15;26(10):1188e1192.

6. Nassr A, Khan MH, Ali MH, et al. Donor-site complications of autogenous nonvascularized fibula strut graft harvest for anterior cervical corpectomy and fusion surgery: experience with 163 consecutive cases. Spine J. 2009 Nov;9(11): 893e898.

5. Zeng J, Duan Y, Yang Y, et al. Anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage for cervical spondylotic myelopathy: a minimum 5-year follow-up study. Medicine (Baltimore). 2018 Feb;97(5). e9724.

4. Patel CK, Fischgrund JS. Complications of anterior cervical spine surgery. Instr Course Lect. 2003;52:465e469.

3. Yone K, Sakou T, Yanase M, Ijiri K. Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy. Spine (Phila Pa 1976). 1992 Oct;17(10 Suppl):S388eS392.

2. Passias PG, Poorman GW, Segreto FA, et al. Traumatic fractures of the cervical spine: analysis of changes in incidence, cause, concurrent injuries, and com-plications among 488,262 patients from 2005 to 2013. World Neurosurg. 2018 Feb;110:e427ee437.

1. Lestini WF, Wiesel SW. The pathogenesis of cervical spondylosis. Clin Orthop Relat Res. 1989 Feb;(239):69e93.