The Journal of Bone and Joint Surgery, Vol 77, Issue 12 1791-1800, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
One-stage anterior cervical decompression and posterior stabilization. A study of one hundred patients with a minimum of two years of follow-up
PC McAfee, HH Bohlman, TB Ducker, SM Zeidman and JA Goldstein
Spine and Scoliosis Center, St. Joseph's Hospital, Baltimore, USA.
One hundred patients were managed with one-stage anterior decompression and
posterior stabilization of the cervical spine. The underlying indication
for the operation was cervical trauma in thirty-one patients; a neoplasm
with a pathological fracture or an incomplete neurological deficit in
fifty-five; and a miscellaneous condition, such as infection, rheumatoid
arthritis, or cervical spondylotic myelopathy, in fourteen. The duration of
follow-up ranged from twenty-four to 108 months (mean, thirty-two months)
for the living patients. Sixteen patients had the procedure after the
failure of an operation that had been performed elsewhere. The development
of more biomechanically rigid cervical instrumentation did not obviate the
need for a combined anterior and posterior approach. Twenty-six patients
(26 per cent) had supplemental cervical instrumentation as part of the
circumferential arthrodesis: seventeen had insertion of an anterior
cervical plate and nine had insertion of a posterior facet plate. There
were no iatrogenic neurological deficits. Of the seventy-five patients who
had had a neurological deficit preoperatively, fifty-one improved one grade
and six improved two grades according to the system of Frankel et al. Of
the thirty-five patients who had not been able to walk preoperatively,
twenty-one regained enough motor strength to walk postoperatively. Because
the anterior and posterior procedures were performed during one session of
general anesthesia, the prevalence of perioperative complications related
to the airway was lower than that previously reported in the literature. No
patient had an obstruction of the airway.
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