title: Multilevel Corpectomy With Anterior Column Reconstruction and Plating for Subaxial Cervical Osteomyelitis.
abstract: METHODS
  A retrospective case series.
  
  
  OBJECTIVE
  The aim of this study was to evaluate patients with cervical spine osteomyelitis who underwent multilevel (≥2) subaxial corpectomies and anterior column reconstruction and plating.
  
  
  BACKGROUND
  Neglected multilevel subaxial cervical osteomyelitis is a potentially dangerous disease. As it is rare, early radiographic and clinical outcomes after multilevel anterior corpectomy and reconstruction for subaxial cervical osteomyelitis are incompletely defined.
  
  
  METHODS
  Adults who underwent multilevel corpectomy and anterior plating/reconstruction for subaxial cervical osteomyelitis at two institutions were reviewed. Analysis of patient demographics, operative details, and radiographic cervical alignment parameters [segmental kyphosis, cervical lordosis, C2-7 sagittal vertical axis (SVA)] was performed.
  
  
  RESULTS
  Nineteen patients [15 males, four females; average age 48 years (20-81 yrs)] met inclusion criteria. The majority had pre-operative neurologic deficits or was immunosuppressed. All were treated with ≥6 weeks of intravenous antibiotics following operation. All had anterior plating/reconstruction with titanium cages (expandable-6; mesh-6) or structural bone graft (fibular allogaft-6; tricortical iliac crest-1). The average number of corpectomies was 2.4 (2-4). The average numbers of levels fused anteriorly was 4.4 (4-6) and posteriorly was 6.3 (4-9). The majority of patients (74%) was treated with an anterior/posterior approach. Average follow-up was 16 ± 9 months. There was significant improvement in all cervical alignment parameters (segmental kyphosis, C2-7 SVA, cervical lordosis). No intraoperative complications occurred and no patient deteriorated neurologically postoperatively. Postoperative complications included anterior cage/graft dislodgement (n = 2), recurrent neck hematomas requiring revision (n = 1), epidural hematoma (n = 1), and wound infection (n = 1). Sixty percent of patients had persistent neurologic dysfunction at final follow-up. None required reoperation for recurrent infection or pseudarthrosis.
  
  
  CONCLUSIONS
  Although overall prognosis and neurologic recovery are guarded in medically fragile patients with multilevel subaxial cervical osteomyelitis, reconstruction with multilevel (≥2) corpectomy and anterior reconstruction/plating results in excellent restoration of cervical alignment and low rates of recurrent infection and pseudarthrosis.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Theologis
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
authors.forename: Drew
authors.initials: D
authors.lastname: Lansdown
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
authors.forename: R Trigg
authors.initials: RT
authors.lastname: McClellan
authors.affiliation: Department of Neurologic Surgery, University of California-San Francisco, San Francisco, CA.
authors.forename: Dean
authors.initials: D
authors.lastname: Chou
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
authors.forename: Murat
authors.initials: M
authors.lastname: Pekmezci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult