Complications and Outcome in Dynamic Plated Single Level Anterior Corpectomy and Fusion Including Two Level Complete Diskectomies

Abstract

Background and Context: The efficacy of iliac crest strut autograft and dynamic plating (ABC: Aesculap, Tuttlingen, Germany) for one level anterior cervical corpectomy/fusion with two level diskectomy (1 level ACF ) needs to be established.Purpose: To document fusion (2D-CT and dynamic X-rays) and outcomes (SF-36) following 1 level ACF.Study Design/Setting: Graft and plate-related complications and outcomes were prospectively evaluated in 86 consecutive patients undergoing 1 level ACF.Patient Sample: Preoperative MR/CT studies documented contiguous two-level disc disease, spondylosis, stenosis and/or ossification of the posterior longitudinal ligament (OPLL).Outcome Measures: Fusion was documented on 2D-CT/dynamic X-rays. Outcomes (Odom's Criteria, Nurick Grades and SF-36 ) were assessed 3, 6, 12, and 24 months postoperatively.Methods: Patients averaged 48 years of age and exhibited moderate/severe preoperative myelopathy (average Nurick Grade 3.0). All underwent 1 level ACF, and were followed an average of 3.5 years (minimum 2 years).Results: Two pseudarthroses, 2 delayed strut fractures, and 1 plate/graft extrusion (5.8% total) developed postoperatively; all required secondary posterior fusion. Outcomes 2 years postoperatively revealed mild residual radiculopathy (average Nurick Grades 0.24), 82 good/excellent outcomes (Odom's Criteria), and marked improvement on 6 SF-36 Health Scales. The average time to fusion was 4.7 months.Conclusions: Successful 2D-CT/dynamic X-ray documented fusion occurred in 94.2% of patients undergoing 1 level ACF performed with iliac crest autograft and dynamic ABC plates. Results were comparable to those cited for fixed-plates in other series.