title: Acute graft extrusion following central corpectomy in patients with cervical spondylotic myelopathy and ossified posterior longitudinal ligament.
abstract: We studied the influence of surgeon experience, number of levels operated and level of the lower mortise on acute graft extrusion in patients undergoing uninstrumented one-level to three-level central corpectomy (CC) for cervical spondylotic myelopathy (CSM) or ossified posterior longitudinal ligament (OPLL). Between 1992 and 2005, 410 consecutive patients underwent one-level to three-level CC with autologous iliac (in one-level and two-level corpectomy) or fibular (in three-level corpectomy) graft. The surgeon's experience was divided into four eras (I-IV; three eras of 100 consecutive patients each and the fourth with the last 110 patients). Eight patients (1.95%) experienced acute graft migration and seven required re-exploration. The graft extrusion rate in the first era was significantly higher than in the other three eras (6%, 1%, 1%, 0%; p=0.01) implying a significant learning curve. The extrusion rates for one-level, two-level and three-level CC were not significantly different (3%, 1.6%, 0% respectively; p=0.3). The extrusion rate for grafts ending in the C7 body (3/230, 1.6%) was not significantly different from the data for grafts ending in other bodies (5/180, 2.8%) (p=0.23). There is a low incidence of acute graft migration in patients undergoing uninstrumented CC with autologous bone grafts with a significant learning curve in avoiding graft extrusion.
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore 632004, Tamilnadu, India.
authors.forename: G Samson Sujit
authors.initials: GS
authors.lastname: Kumar
authors.forename: Vedantam
authors.initials: V
authors.lastname: Rajshekhar
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods