Two-level Corpectomy and Three-level Discectomy Show Similar Outcomes for Cervical Spondylotic Myelopathy
Comments by Praveen V. Mummaneni, MD and Darryl Lau, MD
No significant differences in perioperative and long-term neurological outcomes, pain, and complications were found among patients who underwent a 2-level corpectomy or 3-level discectomy alone, according to a retrospective study published in the September Journal of Neurosurgery: Spine.
“It was noted that 2-level corpectomy is associated with more blood loss than 3-level corpectomy, but that blood loss increase typically did not result in the need for blood transfusion,” said lead author said senior author Praveen V. Mummaneni MD, Professor and Vice Chair of the Department of Neurological Surgery, University of California, San Francisco (UCSF).
“We typically reserve 2-level corpectomy for cases with compressive pathology posterior to the center of the vertebral body. One other additional issue is that if supplemental posterior spinal fusion is added to either 2-level corpectomy or 3-level discectomy, then the complication rates are higher,” Dr. Mummaneni said.
Retrospective Study Design
Dr. Mummaneni and colleagues studied all patients who underwent 2-level anterior cervical corpectomy and fusion (ACCF; n=20) or 3-level anterior cervical discectomy and fusion (ACDF; n=35) in the treatment of cervical spondylotic myelopathy between 2006 and 2012. All the patients experienced significant improvements in cervical lordosis after surgery. While radiographic findings showed a trend toward greater improvement in cervical lordosis among patients who underwent 3-level ACDF than among those who underwent 2-level ACCF, the difference was not statistically significant (sagittal Cobb angle 12.1˚ vs 7.2˚, respectively; P=0.173).
- No statistically significant differences between ACCF and ACDF groups were found for other outcomes, including operative adjacent-segment disease requiring surgery (6.3% vs 3.6%; P=0.682), radiographic pseudoarthritis rate (6.3% vs 7.1%; P=0.909), visual analog scale pain scores (3.4 vs 3.2; P=0.860), and Nurick scores (0.8 vs 0.7; P=0.925).
- Estimated blood loss was significantly higher with 2-level ACCF than with 3-level ACDF for the anterior state of surgery (382.2 mL vs 117.9 mL; P<0.001).
- In addition, 2-level ACCF was associated with a significantly lower hospital stay (7.2 days vs 3.9 days; P=0.048); however, this difference was no longer significant in a subgroup analysis that excluded patients with second-stage posterior spinal fusion (3.1 days vs 4.4 days; P=0.267).
Findings May Help With Clinical Decision Making
“This data is helpful to surgeons when counseling and informing patients about the 2 different procedures,” said first author Darryl Lau, MD, Resident Physician, Department of Neurological Surgery, UCSF. “Clinical decision-making may take into account the similarity of these procedures in terms of outcome and fusion rate and utilize other factors to make a decision of which procedure to utilize,” the authors told SpineUniverse.
“After reviewing this data we have chosen to reserve 2-level corpectomy for cases with compressive pathology posterior to the center of the vertebral body as 2-level corpectomy is associated with a higher blood loss than 3-level ACDF,” Dr. Lau and Dr. Mummaneni said. “One other additional issue is that if supplemental posterior spinal fusion is added to either 2-level corpectomy or 3-level discectomy, then the complication rates are higher,” the authors noted. “So, we try to avoid a supplemental posterior fixation for these cases during the index hospitalization since the pseudarthrosis rates are not significantly different between groups,” they said.
“The main factor that should be taken into account when deciding between use of ACCF and ACDF is the anatomy and pathology seen on imaging,” the authors concluded. “If there is cord compression posterior to the mid-vertebral body, and if it cannot be accessed through a multilevel discectomy approach, only then will we perform a corpectomy,” they said.