Ten- Year Experience of Skip Anterior Cervical Corpectomy and Fusion

Background: Anterior cervical corpectomy , fusion (ACCF) is often required to adequately decompress the spinal cord in patients with multilevel cervical spondylosis. Unfortunately, multilevel corpectomy constructs have high rates of early failure and frequently require supplemental posterior fixation. First described in 2003, skip ACCF (sACCF) is defined by corpectomies above and below an intervening vertebral body, which serves as an additional fixation point to augment biomechanical stability. Subsequent studies report high fusion rates and low construct failure rates secondary to superior biomechanical stability.Objective: The goal of this study was to demonstrate the safety and efficacy of sACCF in the largest series published to date.Methods: This study was a retrospective case series of all patients who underwent sACCF at a single institution over a 10 -year period. Standard demographic and perioperative data were collected. Outcome data included immediate postoperative complications, long -term reoperation , pre-and postoperative radiographic parameters. Results: Forty -five patients underwent sACCF: 42 at C4 -C6 and 3 at C5 -C7. Mean age was 57.5 years. More than half (64.4%) of patients were smokers. Almost all patients were discharged home, the vast majority (82.2%) within 3 days of surgery. Five patients (11.1%) developed complications during the index hospitalization: 2 C5 palsies and 3 medical complications. Three patients (6.7%) developed instrumentation failure requiring anterior revision and supplemental posterior fixation. There were statistically significant increases in C1 -C7 (47.8 vs 41.1, P < 0.001) and C2 -C7 lordosis (11.1 vs 5.0, P < 0.001) on postoperative radiographs compared with preoperative imaging. Average follow -up was 21.1 months. Conclusion: sACCF can be performed safely with complication rates similar to those reported for multilevel anterior cervical discectomy and fusion or adjacent segment ACCF. It should be considered for patients with multilevel cervical pathology for whom an anterior approach is favored.Clinical Relevance: sACCF is an effective surgical technique for multilevel cervical decompression and correction of cervical alignment.Level of Evidence: 3.

Automated summary

This study retrospectively analyzed a series of 45 patients who underwent sACCF. The results showed that sACCF surgery is safe and effective, with complication rates similar to those reported for multilevel anterior cervical discectomy and fusion or adjacent segment ACCF. sACCF should be considered for patients with multilevel cervical pathology.