The Journal of Bone and Joint Surgery, Vol 71, Issue 2 170-182, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting
TA Zdeblick and HH Bohlman
Reconstructive and Traumatic Spine Surgery Center, University Hospital, Cleveland, Ohio.
Between 1976 and 1984, fourteen patients who had severe cervical kyphosis
and myelopathy were treated with anterior decompression and arthrodesis.
Eight had had spondylosis; five, a traumatic injury; and one, a benign
intradural tumor. In eight of the fourteen patients, the severe kyphosis
and myelopathy had developed after a laminectomy of three, four, or five
cervical vertebrae. The laminectomy had been done for the treatment of
spondylosis in five patients, of a traumatic lesion in two, and of a tumor
in one. Considering all fourteen patients, an average of 2.25 vertebral
bodies was removed from each, and the average extent of the subsequent
fusion was 3.25 levels. Eight patients (six of whom had spondylosis; one, a
traumatic lesion; and one, a tumor) were treated with a fibular graft that
spanned an average of 4.10 levels, and six patients (four of whom had a
traumatic lesion and two, spondylosis) were treated with an iliac graft
that spanned an average of 2.70 levels. Of the five patients who had a
traumatic lesion, four were treated with anterior decompression and
arthrodesis, combined with posterior arthrodesis that was performed during
the same period of anesthesia. In three patients, the anterior graft
dislodged during the immediate postoperative period. Two of the three
patients had posterior instability due to a prior laminectomy, and in the
third the graft dislodged because of technical difficulties. Two of these
grafts were revised to restore stability. At the latest follow-up, twelve
of the fourteen fusions were solid. In the other two patients, who died six
and ten months postoperatively, the fusion had been solid, as shown by
radiographs, before the time of death. The average amount of correction of
the kyphotic deformities was 32 degrees, a reduction from an average of 45
degrees to an average of 13 degrees. All but one patient had some recovery
of neural function; nine had complete and four, partial recovery. The
remaining patient had relief of pain, but he continued to be completely
quadriplegic although he had some sensory sparing. Of the four patients who
had been unable to walk preoperatively, three were able to walk
postoperatively. No patient lost neural function after the anterior
decompression and arthrodesis. We concluded that, in the presence of severe
cervical kyphosis and myelopathy, adequate anterior decompression of the
spinal cord, correction of the kyphosis, and anterior arthrodesis using a
strut graft can yield excellent results without undue risk.
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