Anterior cervical corpectomy in patients previously managed with a laminectomy: Short-term complications

Background: The purpose of this study was to evaluate the complications of anterior cervical corpectomy and arthrodesis in patients who had had a prev ious cervical laminectomy. The results of previous studies have suggested t hat these patients can be managed with anterior decompression and an arthro desis with either plate fixation or immobilization in a halo vest. However, no studies that we are aware of have specifically focused on the complicat ions of these types of procedures. Methods: The records and radiographs of eighteen patients who had been mana ged with a one to four-level corpectomy with strut-grafting tr ere retrospe ctively reviewed. The reviews were independently performed by the three of us who were not involved in the original operation. The interval between th e laminectomy and the corpectomy ranged from one month to twenty-two years (mean, eight years). Results: Eleven of the eighteen patients sustained a total of sixteen compl ications during the follow-up period, which averaged 2.7 Sears (range, seve n months to six years and four months), and nine of the eleven had graft-re lated complications. Five grafts extruded or collapsed, or both. There were four reoperations. Immobilization in a halo vest did not prevent extrusion s, as three of the four extrusions occurred while the patient more a halo v est. Four patients had a pseudarthrosis. Ln three patients, the kyphosis in creased by 10 degrees or more from the immediate preoperative period to the most recent follow-up evaluation. Two patients had respiratory distress th at necessitated reintubation, one patient had a small dural tear, and one h ad transient dysphagia. Conclusions: Our data suggest that anterior cervical corpectomy without ins trumentation in a patient who has had a previous laminectomy is associated with a great risk of graft-related complications despite the use of a halo vest. This previously unreported finding is relevant in that it contradicts the recommendation previously made by Zdeblick and the senior one of us, w ho advocated postoperative immobilization in a halo vest for these patients . Anterior cervical corpectomy should be performed with caution and knowled ge of the potential complications in a patient who has had a previous lamin ectomy.