J Korean Soc Spine Surg.  2002 Mar;9(1):35-40. 10.4184/jkss.2002.9.1.35.

A Comparison of Fusion Rates and Clinical Results Between Single-Level Cervical Corpectomy and Two-Level Discectomies and Fusion with Plating

• Song KW
• Park IH
• Shin SI
• Lee JY
• Park SJ
• Ahn JH

• KMID: 1897088
• DOI: http://doi.org/10.4184/jkss.2002.9.1.35

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To compare the radiographic and clinical results of two-level discectomies and fusion with plating and a singlelevel corpectomy with plating. SUMMARY OF LITERATURE REVIEW: Previous studies of multisegment fusion have shown decreased fusion rates correlating with the number of increasing levels, and the use of anterior plate in multilevel fusions may be warranted because of the increased pseudoarthrosis rates.
MATERIALS AND METHODS
A total 30 consecutive patients operated at our institutions between Oct. 1995 and Mar. 2000 were entered into this study. Twenty patients with cervical spondylosis had performed two-level discectomies with tricortical bone grafts and plating, and ten patients with cervical myelopathy had a single-level corpectomy with plating. Follow up averaged 2.4 years, radiographic and clinical follow up evaluation was performed. We assessed the radiologic value by postoperative and follow-up sagittal radiograms at monthly intervals until fusion was judged to be solid, and the clinical evaluation by Odom's criteria.
RESULTS
Comparing the radiographic data between the two groups of patients, the values were not different. Of the thirty patients, no non-unions occurred in all patients. The average amount of graft collapse for patients with single-level corpectomy with plating or a two-level discectomy with plating was less than 1 mm for both groups. And, the average amount of kyphotic deformity was less than 1 degrees for both groups. The clinical results of the operations graded by Odom's criteria are no statistical significance between the two groups. (p < 0.9, chi test)
CONCLUSION
There is no significant statistical differences for two-level discectomies with plating and a single-level corpectomy with plating in fusion rate and clinical results, and each methods can be used a viable alternative procedure by anatomical structure that were primarily causing the neural impingement with more reliable fusion rates.

Keyword

Cervical spine; Fusion; Corpectomy; Two-level discectomies

MeSH Terms

Congenital Abnormalities
Diskectomy*
Follow-Up Studies
Humans
Pseudarthrosis
Retrospective Studies
Spinal Cord Diseases
Spondylosis
Transplants

Figure

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  Fig. 1. Preoperative lateral radiography of 57 years old man shows disc degeneration of C4-5, C5-6 and segmental instability at the level of C4-5, C5-6 in flexion-extension views. MRI shows posterior epidural mass at C4-5 and C5-6 disc level on T2-weighted sagittal image. Postoperative 1 month followup lateral radiography shows no change of lordotic curve after two level discectomy and fusion with plating. Postoperative 2 month followup lateral radiography shows breakage of screws on C4 vertebral body and loss of cervical lordosis by 5°. Postoperative 1 year followup lateral radiography shows maintenance of kyphotic angle and solid fusion of graft bone.

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  Fig. 2-A. Preoperative lateral radiography of 46 years old woman shows cervical kyphotic angle by 20° and anterior subluxation of C4 on C5. Fig. 1-B. Postoperatively lateral radiography with C5 corpectomy and C4-6 anterior interbody fusion with tricortical bone graft and plate shows increased cervical lordosis angle by 5°. Postoperative 1.5 year followup lateral radiography shows no loss of cervical lordotic curve.

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  Fig. 3-A. Preoperative lateral radiography with 46 years old man shows narrowed disc space and calcification along the posterior longitudinal ligament from the upper portion of C4 to lower portion of C6. Also the abnormal ossification was shown in sagittal and axial CT scan. Fig. 1-B. Postoperative 1, 3, 6 month followup radiographies with C5 corpectomy and C4-6 anterior interbody fusion with tricortical bone graft and plate show cervical lordotic angle by 20°and no evidence of graft collapse.

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