Anterior corpectomy and fusion to C2 for cervical myelopathy: clinical results and complications.

Abstract

Anterior cervical corpectomy and fusion (ACCF) to C2 (ACCF-C2) for multilevel lesions is a challenging procedure that is indicated for massive ossification of the posterior longitudinal ligament (OPLL) extending to C2 or stenosis at the upper cervical region accompanied by kyphosis. However, there is little information on the effectiveness of and complications related to ACCF-C2. The purpose of this study was to investigate the overall surgical results and postoperative complications of ACCF-C2 for cervical myelopathy. Sixteen patients who underwent ACCF-C2 for OPLL and cervical spondylotic myelopathy were evaluated. An iliac bone or a fibular strut was grafted using a cervical plate. The mean fusion level was 3.8, and the mean follow-up period was 36 months. Patients' charts, clinical results assessed using the Japanese Orthopedic Association (JOA) scale, and radiographs were retrospectively reviewed. The average preoperative JOA score was 11.5 ± 3.5, and improved significantly to 13.1 ± 3.2 at 24 months after surgery (P < 0.01). The postoperative cervical alignment was significantly improved at the last follow-up (P < 0.05). Seven patients experienced complications, including neurological complications in three, graft-related complications in three, cerebrospinal fluid leakage in two, late retropharyngeal perforation in one, and dysphasia in one. Three of 16 patients experienced upper airway obstruction in this series, and 2 of 473 patients who underwent anterior cervical decompression and fusion at lower levels in the same period (P < 0.001). ACCF-C2 is effective for massive OPLL and stenosis accompanied by kyphosis. To avoid complications, skilled decompression and bone grafting technique are necessary, and delayed extubation for upper airway obstruction is preferable.