A retrospective comparative study.
The purpose of this study was to compare the stability and outcomes of a hybrid technique with those of a 3-vertebra corpectomy
in the management of 4-segment cervical myelopathy.
Summary of Background Data:
Patients with primarily ventral disease and loss of cervical lordosis are considered good candidates for anterior surgery. Cervical corpectomy
is commonly performed in patients with multilevel cervical myelopathy
. Corpectomies including >3 vertebraes entail an extremely high risk of reconstruction failure. To avoid the need to perform a 3-vertebra corpectomy
, we use a hybrid decompression and fixation technique. This hybrid technique is a technique to obtain optimum decompression and fixation in patients with multilevel cervical myelopathy
A total of 81 patients with multilevel cervical myelopathy
who underwent 4-segment cervical fixation with a minimum 2-year follow-up were included.
The hybrid technique involved combining a plated 2-vertebra corpectomy
and single-level discectomy with stand-alone cage fixation. This technique was performed in 39 patients, and the plated 3-vertebra corpectomy
was performed in 42 patients. Nine patients (21%) who underwent the plated 3-vertebra corpectomy
were treated with halo immobilization, but no patient in the hybrid group required this treatment (P
=0.002). There were fewer instances of reconstruction failure in the hybrid group than in the 3-vertebra corpectomy
group (0% vs. 10%, respectively; P
=0.048) and fewer instances of C5 palsy
(3% vs. 17%, respectively; P
<0.0001). The incidence of postoperative C5 palsy
was 25% for C3–C5 corpectomy
, 19% for C4–C6 corpectomy
, and 11% for C4–C5 corpectomy
The hybrid technique has the following advantages over 3-vertebra corpectomy
for 4-segment cervical fixation: a shorter graft bone and plate are required; the fixed segment has greater initial stability; postoperative external immobilization is simplified; and the risk of reconstruction failure and postoperative C5 palsy
is reduced markedly.