Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders

Object. To evaluate the applicability and safety of single-stage combined a nterior-posterior decompression and fusion for complex cervical spine disor ders, the authors retrospectively reviewed 72 consecutive procedures of thi s type performed using a uniform technique at a single center. Methods. The indications for decompression and stabilization included: post laminectomy kyphosis (15 patients), trauma (19 patients), spondylosis and c ongenital stenosis (32 patients), and ossification of the posterior longitu dinal ligament (six patients). All patients underwent anterior cervical cor pectomies in which allograft fibula and plates were placed, with 89% of pat ients undergoing two- or three-level procedures (range one-four levels). La teral mass plating with autograft (morselized iliac crest) fusion was perfo rmed in all patients while the same anesthetic agent was still in effect. A hard cervical collar was used postoperatively in all patients (mean 13 wee ks). All patients were followed for a minimum of 2 years (mean 29 months). Fusion was determined to be successful in all 72 patients (100%). Although the short-term morbidity rate reached 32%, the significant long-term morbid ity rate was only 5%. At the 2-year follow-up examination, anterior cervica l plate dislodgment was seen in one patient, and 16 of the 516 lateral mass screws implanted were observed to have partially backed out. However. ther e were no cases of nerve root injury, strut graft extrusion, or anterior pl ate or screw fracture. There were no clinically significant hardware compli cations and no patient required repeated operation. Conclusions. The combined single-stage anterior-posterior decompression, re construction and instrumentation procedure represents a viable option in th e treatment of a select group of patients with complex cervical spinal diso rders. The technique provides immediate rigid stabilization of the cervical spine, prevents anterior plate failure or strut graft extrusion, and elimi nates the need for halo immobilization postoperatively. Furthermore, a high er rate of fusion is achieved with this combined approach than with the ant erior approach alone.