An argument for traditional posterior cervical fusion techniques: evidence from 35 cases

BackgroundFor patients with adequate preservation of the cervical lordotic curvature, focal laminectomy (1-3 levels), and multilevel posterior fusion offer decompression with immediate stabilization. For lateral mass/pedicle screw techniques, CT-guided cadaveric studies document a 13.4% incidence of noncritical, and 10.6% frequency of critical pedicle breaches. Without CT guidance, fewer critical breaches (1.4%-9%) occur in patients who exhibit even fewer neurovascular injuries. Alternatively, for 35 patients undergoing focal laminectomy with posterior fusions using spinous process-based wiring techniques, no screw-related neurovascular injuries occurred, whereas 100% of patients fused.MethodsPatients averaged 65 years of age (22 men and 13 women) and exhibited severe myelopathy (Nurick grade 4.1). Dynamic x-ray and MR/CT studies documented preserved cervical lordotic curvatures and cord compression (stenosis, OPLL, OYL, olisthy). Patients required, on average, 2 level laminectomies (range, 1-3) and 7 level posterior fusions. Fusions used spinous process-based wiring techniques with iliac autograft/bone graft expanders. One-year SF-36 and 2-year fusion (dynamic x-rays/2D-CT) rates and Odom's criteria were assessed.ResultsTwo years postoperatively, patients exhibited mild radiculopathy (Nurick grade 0.3). Complications included 2 transient root injuries (diabetic patients), 2 wound infections, 1 wound breakdown, no cord injuries, and no mortalities. Fusion occurred in 100% of patients an average of 5.2 months postoperatively. Odom's criteria revealed 29 good/excellent and 6 fair/poor outcomes, whereas SF-36 data revealed improvement on all 8 health scales.ConclusionsFocal cervical laminectomies using multilevel posterior fusions, based on spinous process wiring techniques, resulted in high fusion rates with limited morbidity.