title: Anterior corpectomy and fusion with fibular strut grafts for multilevel cervical myelopathy.
abstract: OBJECTIVE
  The authors conducted a study to investigate the long-term results and postoperative complications of a new surgical technique, fibular strut graft-assisted anterior corpectomy and fusion for multilevel (> four) cervical myelopathy. Multilevel anterior corpectomy and subsequent strut graft placement is considered a challenging procedure because of complications relating to graft dislodgment, pseudarthrosis, greater operative duration, and increased blood loss.
  
  
  METHODS
  The study comprised 100 patients with cervical myelopathy who underwent anterior corpectomy and fusion and fibular strut graft placement at more than four disc space levels between 1989 and 1998. Single-screw fixation was used in conjunction with the autologous strut graft. Preoperative and postoperative plain radiographs, computerized tomography myelograms, and magnetic resonance images were obtained for assessment of fusion status. All complications and outcomes were analyzed based on clinical records to evaluate the results of the technique. There were no cases of graft dislodgment. The graft union rate was 85%. Analysis of clinical data showed that pseudarthrosis had no adverse effect on the clinical results. Adjacent-level disc degeneration occurred in 12% of patients, but in all cases the patients were asymptomatic. In 9% of cases C-5 palsy was observed but it recovered spontaneously. There were no infections and no case of neurological deterioration.
  
  
  CONCLUSIONS
  With this new graft technique, graft dislodgment, the major complication associated with strut graft surgery, was resolved completely. This simple technique involving single-screw fixation provided good results when used in conjunction with anterior decompression and strut graft fixation with a very low incidence of complications.
authors.affiliation: Department of Orthopedic Surgery, Kyoto City Hospital, Kyoto, Japan. taketori@nyc.odn.ne.jp
authors.forename: Minoru
authors.initials: M
authors.lastname: Ikenaga
authors.forename: Jitsuhiko
authors.initials: J
authors.lastname: Shikata
authors.forename: Chiaki
authors.initials: C
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D001863:Bone Screws; D016025:Bone Transplantation / Q000009:adverse effects; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009192:Myelography; D009422:Nervous System Diseases / Q000209:etiology; D019637:Orthopedic Procedures / Q000009:adverse effects; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology; D011542:Pseudarthrosis / Q000209:etiology; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome