Anterior decompression via a wide transvertebral approach and a ceramic insert in a patient with cervical degenerative disease.
BACKGROUND
The transvertebral approach is useful for decompression in patients with cervical radiculopathy; because the intervertebral disk is preserved, moveability is retained. We performed wide deletion of the vertebral body to increase the patient population eligible for treatment with this approach and include patients with compression of the cervical spinal cord.


METHODS
In patients undergoing anterior decompression, we performed vertebrotomy (13 x 8 mm) at the midline of the cervical vertebral body at the upper level using a surgical saw. The resulting hole facilitates decompression of the cervical cord and nerve root; a ceramic insert is introduced in the area of deletion. To prevent graft extrusion, the bilateral wings of the bone graft are fastened with bioabsorbable screws.


RESULTS
We used this approach in 163 patients with several cervical diseases. Collapse of the vertebral body and fusion of the operated intervertebral disk were encountered in only 1 patient (0.61%). There was no significant difference between pre- and postoperative alignment. Reoperation was required in 7 patients whose symptoms did not improve, in 1 with disk hernia, in 5 with severe spondylosis, and in 1 with combined-type OPLL.


CONCLUSIONS
Although this approach is appropriate in patients undergoing cervical anterior decompression, the narrowness of the visual field may result in insufficient decompression, and its indication is restricted to patients with cervical disk hernia, mild cervical spondylosis, and segmental OPLL. In patients with segmental instability, continuous or combined OPLL, severe cervical spondylosis, and kyphosis, this approach should not be used.
Kim
Kyongsong
K
Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido 085-8533, Japan. kyongson@nms.ac.jp
Isu
Toyohiko
T
Sugawara
Atsushi
A
Matsumoto
Ryoji
R
Isobe
Masanori
M
D000328:Adult; D000368:Aged; D001863:Bone Screws / Q000639:trends; D016025:Bone Transplantation / Q000379:methods; D002516:Ceramics / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D019736:Prostheses and Implants; D011843:Radiculopathy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome