Comparison of multisegment anterior cervical fixation using bone strut graft versus a titanium rod and buttress prosthesis: analysis of outcome with long-term follow-up and interview by independent physician.

Abstract

STUDY DESIGN: A retrospective study of 73 consecutive patients who underwent cervical corpectomy and anterior strut fixation over 3 or more disc levels between July 1989 and May 1999. OBJECTIVE: To compare the efficacy of cervical spine fixation by autologous strut graft from iliac crest or fibula versus a titanium prosthesis without bone graft. SUMMARY OF BACKGROUND DATA: Strut grafting after multilevel anterior cervical corpectomy remains a challenging procedure, with published dislocation rates from 0% to 71%, and nonunion from 0% to 54%. This paper describes a quicker and easier alternative to the use of a bone strut, imparting a very high degree of immediate spinal stability, and osseous integration equivalent to bone fusion. METHODS: Thirty-eight bone-graft operations and 38 titanium prosthesis operations were performed on 73 patients between July 24, 1989 and May 20, 1999. Average follow-up was 53.2 months (range 19.8-134). RESULTS: The group of patients who received the prosthesis was significantly older than the bone-grafted group and required significantly more segments excised, but operation times were significantly shorter than for the bone strut operation. The titanium prosthesis had a lower incidence of dislodgement in the early postoperative period (1/38 vs. 4/38 for bone struts) but a higher rate of late reoperation (4/38 vs. 1/38 for bone struts). The SF-36 scores in the domain of Physical Function (only) were significantly higher in the bone-grafted group (P = 0.016, Mann Whitney), consistent with the difference in mean ages of the 2 groups. The groups were indistinguishable by Odom criteria, patient verdict, pain scores, analgesic intake, length of hospital stay, radiologic fusion rate, and residual symptoms. CONCLUSION: A titanium rod and buttress prosthesis may be a faster and easier alternative to conventional iliac crest/fibula autograft after multisegmental cervical vertebral corpectomy.