Hybrid Corpectomy and Disc Arthroplasty for Cervical Spondylotic Myelopathy Caused by Ossification of Posterior Longitudinal Ligament and Disc Herniation.
World Neurosurg. 2016 Jul 26;
Authors: Chang HC, Tu TH, Chang HK, Wu JC, Fay LY, Chang PY, Wu CL, Huang WC, Cheng H
INTRODUCTION: Combination of ACDF and ACCF (Anterior cervical discectomy or corpectomy with fusion) has been demonstrated to be effective for multi-level CSM (cervical spondylotic myelopathy). However, the combination of ACCF and cervical disc arthroplasty (CDA) for three-level CSM has never been addressed.
METHODS: Consecutive patients (>18 years old) with CSM caused by segmental ossification of posterior longitudinal ligament (OPLL) and degenerative disc disease (DDD) were reviewed. Inclusion criteria were patients who underwent hybrid ACCF and CDA surgery for symptomatic three-level CSM with OPLL and DDD. Medical and radiological records were retrospectively reviewed.
RESULTS: A total of 15 patients were analyzed with a mean follow-up of 18.1±7.42 months. Every patient had hybrid surgery composed of one-level ACCF (for segmental type OPLL causing spinal stenosis) and one-level CDA at the adjacent level (for DDD causing stenosis). All clinical outcomes, including visual analog scale (VAS) of neck and arm pain, neck disability index (NDI), Japanese Orthopedic Association (JOA) scores, and Nurick scores of myelopathy, demonstrated significant improvement at 12 months after surgery. All patients (100%) achieved arthrodesis for the ACCF (instrumented) and preserved mobility for CDA (Pre-operation 6.2±3.81 degrees versus post-operation 7.0±4.18 degrees; p=0.579).
CONCLUSION: For patients with multi-level CSM caused by segmental OPLL and DDD, the hybrid surgery of ACCF and CDA demonstrated satisfactory clinical and radiological outcomes. Moreover, although located next to each other, the instrumented ACCF construct and CDA still achieved solid arthrodesis and preserved mobility, respectively. Therefore, hybrid surgery may be a reasonable option for the management of CSM with OPLL.
PMID: 27474455 [PubMed – as supplied by publisher]