Complication avoidance in 116 dynamic-plated single-level anterior corpectomy and fusion

Complications arising over a 6-year interval after 116 single-level anterior corpectomy/fusions (ACF) using iliac crest autograft and dynamic ABC plates were sequentially evaluated. Patients averaged 45 years of age (52 females and 64 males). Preoperative magnetic resonance and computed tomography studies documented adjacent 2-level disease/retrovertebral extension. Single level ACF (eg, C5-C7) used iliac crest autograft and dynamic ABC plates (Aesculap, Tuttlingen, Germany). Patients underwent dynamic x-ray and 2D-computed tomography evaluations 3, 4.5, 6, and up to 12 months postoperatively until fusion was documented by 2 independent radiologists. Patient were followed an average of 3.2 years (minimum 1 y). Three patients undergoing surgery in the first year of the study exhibited plate/graft extrusion (1 to 3 wk) or pseudarthroses (2 to 6 mo); subsequent improvements in surgical technique eliminated these complications in the last 5 years of the study. Inadequate bracing (4 mo on average) over the first 2 years was presumed responsible for 2-delayed strut fractures requiring secondary surgery (6 mo, and 2 y/Lupus/steroids) and 5 managed nonsurgically had 3 to 6 months of additional bracing. The routine addition of 6 weeks of cervicothoracic orthoses bracing in the latter 4 years of the study eliminated these strut fractures. Of interest, only 1 patient developed symptomatic adjacent level disease requiring a laminectomy (C6, C7) and posterior fusion (C2-T2) 5 years later. Complications observed in the first 2 years of a study involving 116 single-level dynamic-plated ACF were largely eliminated by introducing more prolonged bracing and improved surgical techniques for the study's last 4 years.