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

Area of Science:

• Spine Surgery
• Orthopedic Surgery
• Neurosurgery

Background:

• Anterior corpectomy/fusion (ACF) with iliac crest autograft and dynamic plates is used for spinal disease.
• Evaluating complications of ACF is crucial for refining surgical techniques and patient management.

Purpose of the Study:

• To sequentially evaluate complications over a 6-year period following single-level anterior corpectomy/fusions (ACF).
• To identify factors contributing to early complications and assess the impact of improved surgical techniques and bracing protocols.

Main Methods:

• A review of 116 patients undergoing single-level ACF (C5-C7) using iliac crest autograft and dynamic ABC plates.
• Postoperative follow-up included dynamic X-rays and CT scans up to 12 months, with an average follow-up of 3.2 years.
• Complications were analyzed, distinguishing between early (first 2 years) and later outcomes, correlating with surgical technique and bracing duration.

Main Results:

• Early complications (plate/graft extrusion, pseudarthrosis) occurred in 3 patients within the first year, linked to initial surgical techniques.
• Delayed strut fractures (2 cases) and non-union (5 cases) were associated with inadequate bracing (average 4 months).
• Implementing improved surgical techniques and routine 6-week cervicothoracic orthosis bracing in the latter 4 years eliminated these specific complications. Only one case of symptomatic adjacent level disease was noted 5 years post-surgery.

Conclusions:

• Complications in single-level dynamic-plated ACF can be significantly minimized through refined surgical techniques and optimized postoperative bracing.
• Prolonged bracing (6 weeks) effectively prevented delayed strut fractures and non-union.
• The study demonstrates a learning curve effect, with improved outcomes achieved after initial technical and management adjustments.