Resident Physician Carolinas Medical Center/Carolina Neurosurgery & Spine Associates Charlotte, North Carolina, United States
Introduction: Anterior cervical corpectomy and fusion (ACCF) is often required to adequately decompress the spinal cord in patients with multilevel cervical spondylosis. Unfortunately, multilevel corpectomy constructs have high rates of early failure and frequently require supplemental posterior fixation. First described in 2003, skip anterior cervical corpectomy and fusion (sACCF) is defined by corpectomies above and below an intervening vertebral body, which serves as an additional fixation point to augment biomechanical stability. Subsequent studies report high fusion rates and low construct failure rates secondary to superior biomechanical stability.
Methods: This study was a retrospective case series of all patients who underwent sACCF at a single institution over a 10-year period. Standard demographic and perioperative data were collected. Outcome data included immediate postoperative complications, long-term reoperation, and pre- and postoperative radiographic parameters.
Results: Forty-five patients underwent sACCF: 42 at C4/C6 and 3 at C5/C7. Mean age was 57.5 years. Over half (64.4%) of patients were smokers. Almost all patients were discharged home, the vast majority (82.2%) within 3 days of surgery. Five patients (11.1%) developed complications during the index hospitalization: two C5 palsies and three medical complications. Three patients (6.7%) developed instrumentation failure requiring anterior revision and supplemental posterior fixation. There were statistically significant increases in C1-C7 (47.8 vs. 41.1, p< 0.001) and C2-C7 lordosis (11.1 vs. 5.0, p< 0.001) on postoperative radiographs compared to preoperative imaging. Average follow-up was 21.1 months.
Conclusion : sACCF can be performed safely with complication rates similar to those reported for multilevel ACDF or adjacent segment ACCF. It should be considered for patients with multilevel cervical pathology for whom an anterior approach is favored.
