Reoperation rates for acute graft extrusion and pseudarthrosis after one-level anterior corpectomy and fusion with and without plate instrumentation: etiology and corrective management.
BACKGROUND
Reoperation rates after one-level anterior cervical corpectomy with fusion (ACF) performed without and with plates need further evaluation.


METHODS
Reoperation rates for graft extrusion and symptomatic pseudarthrosis were analyzed following 48 nonplated (1989-1996) and 35 plated (1997-2000) one-level ACF. Preoperatively, patients typically exhibited mild/moderate myelopathy attributed to spondylostenosis and ossification of the posterior longitudinal ligament (OPLL). Thirty-five ACF were performed with plates: 3 Orion, 12 Atlantis, and 20 ABC Aesculap plates. Fusion was documented on both dynamic X-rays and 2- or 3-dimensional CT studies 3 and 6 months postoperatively, or until fusion occurred. Follow-up averaged 82 months for the nonplated patients, and 21 months for the plated patients.


RESULTS
Out of 48 nonplated patients, 3 developed immediate graft extrusions within 24 hours of surgery requiring graft replacement. Another 2 exhibited symptomatic pseudarthrosis 6 months postoperatively, and required secondary posterior wiring with fusion (PWF). In comparison, 1 of the 35 patients with plated one-level ACF developed plate displacement 6 weeks postoperatively, while 3 exhibited symptomatic pseudarthrosis 6 months after surgery, and required secondary posterior wiring and fusion (PWF).


CONCLUSIONS
Comparison of one-level ACF performed with and without plates showed that plating did not appear to reduce pseudarthrosis or graft extrusion rates.
Epstein
N E
NE
The Albert Einstein College of Medicine, Bronx, New York, USA.
D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects; D016025:Bone Transplantation / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007403:Intervertebral Disc / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011542:Pseudarthrosis / Q000209:etiology* / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed