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Risk Factors for Early Reconstruction Failure of Multilevel Cervical Corpectomy With Dynamic Plate Fixation

Okawa, Atsushi, MD, PhD; Sakai, Kenichiro, MD, PhD; Hirai, Takashi, MD; Kato, Tsuyoshi, MD, PhD; Tomizawa, Shoji, MD, PhD; Enomoto, Mitsuhiro, MD, PhD; Kawabata, Shigenori, MD, PhD; Takahashi, Makoto, MD, PhD; Shinomiya, Kenichi, MD, PhD

doi: 10.1097/BRS.0b013e3181e0f06a

Study Design. Retrospective case series.

Objective. To investigate risk factors for early reconstruction failure of multilevel cervical corpectomy with dynamic plate fixation.

Summary of Background Data. For anterior cervical decompression and fusion, reinforcement by plate fixation was performed to decrease early reconstruction failure and to increase the fusion rate. However, a relatively high complication rate such as graft dislodgement, has been reported in patients undergoing multilevel corpectomy and reconstruction. Risk factors associated with early reconstruction failure have not been explicitly described.

Methods. In 30 instrumented multilevel corpectomy and reconstruction, medical records and radiographic studies were reviewed to investigate risk factors with regard to sagittal alignment of the cervical spine, graft subsidence, screws used in fixation, endplate preparation, and intermediate screw for fibular graft.

Results. Reconstruction failures included anterior slipping at the bottom of the graft in 2 cases, fracture of the C7 vertebral body in 2 cases, and pullout of a screw in 2 cases. Four patients were found to have nonunion of the graft at the final follow-up, but none had experienced early reconstruction failure.

On radiologic measurement, the fusion area lordotic angle after surgery in the patients with reconstruction failures was significantly larger than that of the patients with no complications. The postoperative C2–C7 lordotic angles of the patients with reconstruction failure were also larger, but this trend was not statistically significant. No other factor, such as age and gender, type of screw used, intermediate screw or preservation of the endplates was related to reconstruction failures in this study.

Conclusion. Postoperative cervical hyperlordosis may adversely affect graft stability in the early postoperative period of the surgery of corpectomy and reconstruction with dynamic plate fixation.

A retrospective case series of 30 patients with multilevel cervical corpectomy and reconstruction with dynamic plate fixation was conducted. Six patients experienced early reconstruction failures such as graft migration, C7 vertebral fracture or screw pullout. Hyperlordotic alignment of the fused area seemed to increase shear stress, resulting in reconstruction failures.

Department of Orthopedic and Spinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

Address correspondence and reprint requests to Atsushi Okawa, MD, PhD, Department of Orthopedic and Spinal Surgery, Tokyo Medical and Dental University, Yushima 1–5-45, Bunkyo-Ku, Tokyo 113– 8519, Japan; E-mail:

Acknowledgment date: October 28, 2009. First revision date: February 12, 2010. Second revision date: March 12, 2010. Acceptance date: March 12, 2010.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No 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.

© 2011 Lippincott Williams & Wilkins, Inc.