Anterior cervical corpectomy and strut graft fusion using a different method.
BACKGROUND
Strut graft fusion after corpectomy is frequently indicated for certain pathologies in the cervical spine. The "key-hole" technique and "dove-tail" technique are the popular methods used to insert the strut graft at present. Segmental collapse secondary to seating of the graft on cancellous bone and cord injury from placement or dislodgement the graft are our concerns. Our method was designed to solve these possible problems without affecting the arthrodesis.


OBJECTIVE
To evaluate the results of this method that allows the graft to seat on both the hard end plate and cancellous bone of the upper and lower contacting vertebrae in a easy and safe way after varying levels of corpectomy in the cervical spine.


METHODS
A retrospective clinical and radiographic study conducted by an independent observer was performed on 23 patients treated with this different strut grafting method after cervical corpectomy, with at least 2 years of follow-up.


METHODS
A total of 23 patients from 1983 to 1994 underwent fusion using our strut grafting method with fibular allograft packed with autogenous bone. No augmented internal instrumentation was used in all these patients. The patients with an incomplete record or less than 2 years of follow-up were excluded beforehand.


METHODS
Clinical outcome was assessed by a score based on three factors: neck pain, dependence on medicine and ability to return to work. The total score of these factors was seven. A score from 0 to 3 was defined as satisfactory, and a score from 4 to 7 was defined as unsatisfactory. The result of graft fusion, collapse of interbody height and loss of lordotic angle corrected by the graft were evaluated through the radiographic studies.


METHODS
The operative technique creates a notch in the anterior cortex and end plate of the respective superior and inferior vertebraes. Cylinder allograft filled with autogenous cancellous bone was used as bone graft for all patients. The bone graft is cut with corresponding pegs at both ends. The graft is inserted into the corpectomy space with the pegs inserted into the notches and the remainder of the graft placed onto the preserved superior and inferior bony end plates.


RESULTS
Twenty patients achieved successful fusion (87%). On average, the loss of anterior and posterior interbody height was 2.79 mm and 2.93 mm, respectively. The average loss of lordotic correction was 2.83 degrees. Eighty-three percent achieved satisfactory clinical outcomes. There were no neurologic injuries encountered during the operation. Partial graft dislodgment occurred in two patients (8.7%).


CONCLUSIONS
This different method of strut grafting after cervical corpectomy has proven its safety and efficacy in its fusion and clinical results.
Department of Orthopedics, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street 333, Kweishian, Taoyuan, Taiwan. niuchien@adm.cgmh.org.tw
Chi-Chien
CC
Niu
Yong
Y
Hai
Bruce E
BE
Fredrickson
Hansen A
HA
Yuan
D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome