Reoperation rates for acute graft extrusion and pseudarthrosis after one-level anterior corpectomy and fusion with and without plate instrumentation: etiology and corrective management.

BACKGROUND: Reoperation rates after one-level anterior cervical corpectomy with fusion (ACF) performed without and with plates need further evaluation.

METHODS: Reoperation rates for graft extrusion and symptomatic pseudarthrosis were analyzed following 48 nonplated (1989-1996) and 35 plated (1997-2000) one-level ACF. Preoperatively, patients typically exhibited mild/moderate myelopathy attributed to spondylostenosis and ossification of the posterior longitudinal ligament (OPLL). Thirty-five ACF were performed with plates: 3 Orion, 12 Atlantis, and 20 ABC Aesculap plates. Fusion was documented on both dynamic X-rays and 2- or 3-dimensional CT studies 3 and 6 months postoperatively, or until fusion occurred. Follow-up averaged 82 months for the nonplated patients, and 21 months for the plated patients.

RESULTS: Out of 48 nonplated patients, 3 developed immediate graft extrusions within 24 hours of surgery requiring graft replacement. Another 2 exhibited symptomatic pseudarthrosis 6 months postoperatively, and required secondary posterior wiring with fusion (PWF). In comparison, 1 of the 35 patients with plated one-level ACF developed plate displacement 6 weeks postoperatively, while 3 exhibited symptomatic pseudarthrosis 6 months after surgery, and required secondary posterior wiring and fusion (PWF).

CONCLUSIONS: Comparison of one-level ACF performed with and without plates showed that plating did not appear to reduce pseudarthrosis or graft extrusion rates.