Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting

Between 1976 and 1984, fourteen patients who had severe cervical kyphosis and myelopathy were treated with anterior decompression and arthrodesis. Eight had had spondylosis; five, a traumatic injury; and one, a benign intradural tumor. In eight of the fourteen patients, the severe kyphosis and myelopathy had developed after a laminectomy of three, four, or five cervical vertebrae. The laminectomy had been done for the treatment of spondylosis in five patients, of a traumatic lesion in two, and of a tumor in one. Considering all fourteen patients, an average of 2.25 vertebral bodies was removed from each, and the average extent of the subsequent fusion was 3.25 levels. Eight patients (six of whom had spondylosis; one, a traumatic lesion; and one, a tumor) were treated with a fibular graft that spanned an average of 4.10 levels, and six patients (four of whom had a traumatic lesion and two, spondylosis) were treated with an iliac graft that spanned an average of 2.70 levels. Of the five patients who had a traumatic lesion, four were treated with anterior decompression and arthrodesis, combined with posterior arthrodesis that was performed during the same period of anesthesia. In three patients, the anterior graft dislodged during the immediate postoperative period. Two of the three patients had posterior instability due to a prior laminectomy, and in the third the graft dislodged because of technical difficulties. Two of these grafts were revised to restore stability. At the latest follow-up, twelve of the fourteen fusions were solid. In the other two patients, who died six and ten months postoperatively, the fusion had been solid, as shown by radiographs, before the time of death. The average amount of correction of the kyphotic deformities was 32 degrees, a reduction from an average of 45 degrees to an average of 13 degrees. All but one patient had some recovery of neural function; nine had complete and four, partial recovery. The remaining patient had relief of pain, but he continued to be completely quadriplegic although he had some sensory sparing. Of the four patients who had been unable to walk preoperatively, three were able to walk postoperatively. No patient lost neural function after the anterior decompression and arthrodesis. We concluded that, in the presence of severe cervical kyphosis and myelopathy, adequate anterior decompression of the spinal cord, correction of the kyphosis, and anterior arthrodesis using a strut graft can yield excellent results without undue risk.