279. Cervical corpectomy vs 2-level discectomy: a comparative study of 100 patients

Abstract

BACKGROUND CONTEXT Surgical treatment of cervical spine degenerative pathology involving 2 levels can be performed anteriorly through a double discectomy or through a corpectomy. It is not clear, however, what is the capacity of each technique in the restoration of cervical lordosis and what is its effect over time. PURPOSE Compare the 2 techniques with respect to clinical and radiographic results, namely in the restoration and maintenance of sagittal cervical balance. METHODS Clinical files and radiographs of patients submitted to a 2-level discectomy (Group A) or a 1-level corpectomy (Group B) were evaluated retrospectively in the treatment of degenerative cervical disease between 2010 and 2017. Radiological parameters were measured (C2-C7 sagittal Cobb, regional cervical lordosis and graft collapse) preoperatively, after 3-6 weeks and at the last follow-up. Patient variables, surgery and perioperative parameters (length of stay, blood loss, surgical time and complications) were compared. RESULTS A total of 100 patients (43 men and 57 women) with a mean age of 60.4 years (40-86) were included. Average follow-up of 3.5 years (8 months-7.3 years). Group A: 18 patients, mean age 60.3, 39% (n\u202f=\u202f7) with radiculopathy and 61% (n\u202f=\u202f11) with myelopathy; Group B: 82 patients, mean age 61.4; 69.5% (n\u202f=\u202f56) with myelopathy, 30.5% (n\u202f=\u202f25) with radiculopathy. There was no statistically significant difference between the 2 groups regarding length of hospital stay, blood loss or surgical time. Patients submitted to a corpectomy had a lower lordosis than those who underwent discectomy at 2 levels (p\u202f=\u202f0.083). However, the gain of lordosis with surgery was similar in both groups, 7.8° in Group B and 6,1° in Group A (p\u202f=\u202f0.582). After surgery, there was a progressive loss of lordosis gain mainly in the first 6 weeks but without significant differences between the groups. (p\u202f=\u202f0.08 at 6 weeks and p\u202f=\u202f0.690 at the last follow-up). CONCLUSIONS In the presence of myelopathy, corpectomy was the preferred surgical option. Preoperatively, these patients had a lower degree of lordosis than those operated by radiculopathy. Both surgical options allowed an equivalent gain in lordosis, which was partially lost during follow-up. There were no advantages of one surgical technique over the other in lordosis gain. Therefore, the decision on the technique to be used must be based on factors other than the concern with the gain of lordosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.