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Comparison of Multisegment Anterior Cervical Fixation Using Bone Strut Graft Versus a Titanium Rod and Buttress Prosthesis: Analysis of Outcome With Long-term Follow-up and Interview by Independent Physician

Brazenor, Graeme Alexander, FRACS (Neurosurgery)

doi: 10.1097/01.brs.0000250304.24001.24
Cervical Spine
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Study Design. A retrospective study of 73 consecutive patients who underwent cervical corpectomy and anterior strut fixation over 3 or more disc levels between July 1989 and May 1999.

Objective. To compare the efficacy of cervical spine fixation by autologous strut graft from iliac crest or fibula versus a titanium prosthesis without bone graft.

Summary of Background Data. Strut grafting after multilevel anterior cervical corpectomy remains a challenging procedure, with published dislocation rates from 0% to 71%, and nonunion from 0% to 54%. This paper describes a quicker and easier alternative to the use of a bone strut, imparting a very high degree of immediate spinal stability, and osseous integration equivalent to bone fusion.

Methods. Thirty-eight bone-graft operations and 38 titanium prosthesis operations were performed on 73 patients between July 24, 1989 and May 20, 1999. Average follow-up was 53.2 months (range 19.8–134).

Results. The group of patients who received the prosthesis was significantly older than the bone-grafted group and required significantly more segments excised, but operation times were significantly shorter than for the bone strut operation. The titanium prosthesis had a lower incidence of dislodgement in the early postoperative period (1/38 vs. 4/38 for bone struts) but a higher rate of late reoperation (4/38 vs. 1/38 for bone struts). The SF-36 scores in the domain of Physical Function (only) were significantly higher in the bone-grafted group (P = 0.016, Mann Whitney), consistent with the difference in mean ages of the 2 groups. The groups were indistinguishable by Odom criteria, patient verdict, pain scores, analgesic intake, length of hospital stay, radiologic fusion rate, and residual symptoms.

Conclusion. A titanium rod and buttress prosthesis may be a faster and easier alternative to conventional iliac crest/fibula autograft after multisegmental cervical vertebral corpectomy.

Retrospective analysis of 76 consecutive corpectomy operations over 3 or more disc levels, comparing stabilization with bone strut in 38 cases with titanium prosthesis in 38. The titanium prosthesis was superior to bone in operation duration and immediate stability but inferior in long-term stability. At long-term follow-up, there was no significant difference between the 2 patient groups.

From the Epworth Hospital, Richmond, Victoria, Australia.

Acknowledgment date: December 21, 2005. First revision date: January 30, 2006. Second revision date: February 25, 2006. Acceptance date: February 28, 2006.

The device(s)/drug(s) that is/are the subject of this manuscript is/are not FDA-approved for this indication and is/are not commercially available in the United States. Corporate/Industry funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Graeme Alexander Brazenor, FRACS, 17 Erin Street, Richmond, Victoria, Australia 3121; E-mail: gbrazenor@optusnet.com.au

© 2007 Lippincott Williams & Wilkins, Inc.