Anterior Cervical Osteotomy for Fixed Cervical Deformities

摘要

Summary of Background Data. Although posteriorly based osteotomies of the cervical spine have been described in the past, there are no reports of the surgical technique for performing an anterior osteotomy of the cervical spine for fixed cervical deformities. Methods. Description of a single surgeon's technique for performing an anterior cervical osteotomy and his experience in performing this technique from 2000 to 2010 in a consecutive series of patients. Demographics, operative details, and clinical/ radiographical outcomes were collected. The cohort was separated into 2 groups. Group 1 had anterior osteotomy only with or without posterior instrumentation whereas group 2 had anterior osteotomy and Smith-Petersen osteotomies with posterior instrumentation. Results. A total of 38 patients (group 1=17, group 2 = 21) underwent an anterior osteotomy in the study period with an average follow-up of 3.4 years (range, 1.0-6.3 yr). All but 7 cases were revision cases. Group 1 had shorter length of surgery and less estimated blood loss than group 2 (length of surgery 220 vs. 313 min, P < 0.01; estimated blood loss 189 vs. 294 mL, P = 0.02). The mean angular correction achieved in group 1 was less than that of group 2, although not statistically significant (23° vs. 33°, P = 0.15). There was less mean translational correction achieved in group 1 compared with group 2 (1.3 vs. 3.7 cm, P = 0.03). Both groups had improvements in the neck disability index with surgery and were similar between groups (20 vs. 19.7, P= 0.78). There were no neurological complications or intraoperative neuromonitoring changes in either group. Conclusion. The use of an anterior osteotomy in the cervical spine is safe and effective for the correction of fixed deformities of the cervical spine. When necessary, Smith-Petersen osteotomies can add to the angular and translational correction to achieve a satisfying outcome for patients.