Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression.

Abstract

STUDY DESIGN:

Reconstruction techniques after multilevel anterior cervical decompression were retrospectively compared.

OBJECTIVE:

To compare radiographic and clinical outcomes of multiple interbody grafting with strut grafting.

SUMMARY OF BACKGROUND DATA:

Previous studies have reported lower fusion rates for anterior cervical decompressions reconstructed with multiple interbody grafts as opposed to a single strut graft, although these techniques have never been directly compared in a consecutive series of patients who underwent surgery by a single surgeon.

METHODS:

Over a 20-year period, 190 patients underwent anterior cervical decompression and autogenous grafting without internal fixation and were followed for an average of 68 months. There were 98 two-level and 33 three-level discectomies with interbody grafting. These were compared with 16 one-level, 21 two-level, 20 three-level, and 2 four-level corpectomies with strut grafting. Radiographic and clinical outcomes were compared between the groups by chi2 and rank-sum analysis, respectively.

RESULTS:

Of the 59 patients who underwent strut grafting, 55 achieved a solid arthrodesis (93%), as compared with 87 of the 131 patients who underwent multiple interbody grafting (66%) (P = 0.0002). There were six cases of graft displacement or extrusion among the 59 patients who had strut grafts, as compared with no graft-related complications among the 131 patients who had interbody grafts (P < 0.0001). More "good" and "excellent" clinical outcomes were found among patients who underwent strut-grafting (88% vs 84%), although the difference was not statistically significant (P = 0.73). However, patients with a pseudarthrosis had significantly poorer clinical outcomes (P < 0.0001).

CONCLUSIONS:

A much higher fusion rate was achieved after corpectomy and strut grafting than after multilevel discectomy and interbody grafting. Although there were strut graft-related complications, four of these six complications occurred among patients who had a postlaminectomy kyphosis. Because pseudarthrosis resulted in poorer clinical outcomes, strut grafting should be considered after multilevel anterior cervical decompression to increase the likelihood of successful fusion.

• Authors: Alan S Hilibrand, Mark A Fye, Sanford E Emery, Mark A Palumbo, Henry H Bohlman
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 27 Issue 2 Pg. 146-51 (Jan 15 2002) ISSN: 1528-1159 [Electronic] United States
• PMID: 11805659 (Publication Type: Comparative Study, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Arthrodesis (methods)
• Bone Transplantation (methods)
• Cervical Vertebrae (pathology, surgery)
• Follow-Up Studies
• Humans
• Middle Aged
• Orthopedic Fixation Devices
• Radiculopathy (diagnosis, pathology, surgery)
• Spinal Osteophytosis (diagnosis, surgery, therapy)
• Transplantation, Autologous
• Treatment Outcome