Interdisciplinary Neurosurgery (Sep 2021)
Hardware failure and reoperation after hybrid anterior cervical corpectomy and discectomy for multilevel spondylotic disease: A retrospective single-institution cohort study
Abstract
Background context: Hybrid cervical corpectomy/ACDF (HCC-ACDF) is commonly utilized to treat multilevel cervical myelopathy; however, the incidence and mechanisms of hardware failure remain largely uncharacterized. Purpose: We report our experience with this procedure with the goal of describing and better understanding post-operative failures. Methods: The records of 20 consecutive patients who underwent HCC-ACDF for multilevel CSM between June 2015 and December 2018 at this Hospital (blinded) were retrospectively reviewed. All patients were followed for at least 1 year after surgery and were therefore included in the study. Outcome measures include incidence of and reason for subsequent posterior cervical surgery, incidence of and reason for subsequent anterior cervical surgery, progressive symptomatic myelopathy, radiographic hardware failure, and net reduction of pre-operative kyphosis. Continuous variables are reported with means and standard deviations. Fisher’s exact test was used to compare outcomes of binary variables. Results: 20 patients (mean age 60) underwent anterior HCC-ACDF for 3-level CSM. Mean clinical follow up was 26 months (range: 12–56 months). Mean operative time was 205 min and mean blood loss was 105 mL. Radiographic fusion was achieved in 15 of 18 (83%) patients for whom adequate radiographic follow-up was available. HCC-ACDF resulted in an average restoration of 4 degrees of cervical lordosis (standard deviation: 7.3 degrees). One patient (5%) developed symptomatic hardware failure requiring additional surgery. One patient (5%) developed progressive myelopathy within 4 months of surgery. 2 others (10%) developed adjacent segment disease within 2 years of surgery. Three of 20 patients (15%) required subsequent posterior surgery. Conclusions: Rates of hardware failure after HCC-ACDF in our series compare favorably with reports of multilevel anterior corpectomy but are higher than those reported in previous series of HCC-ACDF. No patient characteristics were significantly associated with rates of surgical failure.
