Asian Spine J.  2017 Oct;11(5):739-747. 10.4184/asj.2017.11.5.739.

Sagittal Alignment of a Strut Graft Affects Graft Subsidence and Clinical Outcomes of Anterior Cervical Corpectomy and Fusion

• Yamauchi K
• Fushimi K
• Miyamoto K
• Hioki A
• Shimizu K
• Akiyama H

• KMID: 2392657
• DOI: http://doi.org/10.4184/asj.2017.11.5.739

Abstract

STUDY DESIGN: Retrospective study. PURPOSE: The purpose of this study was to investigate the influence of sagittal alignment of the strut graft on graft subsidence and clinical outcomes after anterior cervical corpectomy and fusion (ACCF). OVERVIEW OF LITERATURE: ACCF is a common technique for the treatment of various cervical pathologies. Although graft subsidence sometimes occurs after ACCF, it is one cause for poor clinical results. Malalignment of the strut graft is probably one of the factors associated with graft subsidence. However, to the best of our knowledge, no prior reports have demonstrated correlations between the alignment of the strut graft and clinical outcomes.
METHODS
We evaluated 56 patients (33 men and 23 women; mean age, 59 years; range, 33-84 years; 45 with cervical spondylotic myelopathy and 11 with ossification of the posterior longitudinal ligament) who underwent one- or two-level ACCF with an autogenous fibular strut graft and anterior plating. The Japanese Orthopaedic Association (JOA) score recovery ratio for cervical spondylotic myelopathy was used to evaluate clinical outcomes. The JOA score and lateral radiograms were evaluated 1 week and 1 year postoperatively. Patients were divided into two groups (a straight group [group I] and an oblique group [group Z]) based on radiographic assessment of the sagittal alignment of the strut graft.
RESULTS
Group I showed a significantly greater JOA score recovery ratio (p<0.05) and a significantly lower graft subsidence than group Z (p<0.01).
CONCLUSIONS
Our findings suggest that a straight alignment of the strut graft provides better clinical outcomes and lower incidence of graft subsidence after ACCF. In contrast, an oblique strut graft can lead to significantly increased strut graft subsidence and poor clinical results.

Keyword

Cervical vertebrae; Spinal cord compression; Clinical study; Spinal fusion; Bone transplantation

MeSH Terms

Asian Continental Ancestry Group
Bone Transplantation
Cervical Vertebrae
Clinical Study
Female
Humans
Incidence
Male
Pathology
Retrospective Studies
Spinal Cord Compression
Spinal Cord Diseases
Spinal Fusion
Transplants*