• World Neurosurg · Jul 2020

    Cranial kyphotic change after multilevel anterior cervical corpectomy and fusion may lead to myelopathy recurrence.

    • Norimasa Ikeda, Seiichi Odate, and Jitsuhiko Shikata.
    • Department of Orthopedic Surgery, Spine Center, Gakkentoshi Hospital, Kyoto, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: i22525@yahoo.co.jp.
    • World Neurosurg. 2020 Jul 1; 139: e412-e420.

    ObjectiveTo determine the characteristic alignment change in patients with myelopathy recurrence after multilevel anterior cervical corpectomy and fusion (m-ACCF).MethodsWe analyzed 52 patients who underwent m-ACCF, including 20 who underwent revision surgeries for myelopathy recurrence (R group) and 32 postoperative asymptomatic patients (A group). Classic alignment parameters (cervical lordosis angle, cervical sagittal vertical axis, and fusion area angle and length) and original alignment parameters (α-β, β-bone graft [BG], BG-γ, and γ-δ angles) were measured preoperatively, postoperatively, and at follow-up or before revision surgery. The difference in the amount of change in parameters between groups was analyzed. The relationship between distribution of restenotic lesions and characteristic alignment change in the R group was evaluated.ResultsCervical lordosis angle, fusion area angle, and fusion area length in the R group significantly decreased postoperatively compared with the A group (P < 0.01, P < 0.01, and P = 0.04). Compared with the A group, α-β and β-BG angles in the R group significantly decreased (P < 0.01), indicating kyphotic change on the cranial side. BG-γ and γ-δ angles in the R group significantly increased (P < 0.01), indicating lordotic change in the caudal fused area. Restenotic lesions significantly increased on the cranial side in the R group (cranial side, 19 levels; caudal side, 5 levels; P < 0.01).ConclusionsIn patients with myelopathy recurrence after m-ACCF, the cranial side has significant kyphosis and the caudal side has lordosis. Moreover, 79.2% of the restenotic lesions were significantly maldistributed on the cranial side. Surgeons should pay close attention to cranial kyphosis inducing myelopathy recurrence after m-ACCF.Copyright © 2020 Elsevier Inc. All rights reserved.

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