Single Level Anterior Corpectomy and Fusion for Five Morbidly Obese Patients;

Is Simultaneous Posterior Fusion and Halo Fixation Necessary?

抄録

Do higher graft/plate complication rates occur in morbidly obese patients undergoing single level anterior corpectomy fusion [ACF] alone, and do these patients, therefore, warrant simultaneous posterior fusion? To assess whether initial circumferential surgery should be performed in this unique population, the experience with 5 morbidly obese patients undergoing single level [ACF] performed with [3 patients] and without [2 patients] simultaneous posterior fusion [PF] and halo application were reviewed. Patients averaged 51 years of age and exhibited average Bone Mass Indices [BMI=kg/M2] of 46.8 [BMI=kg/m2]. Neurological examinations reflected moderate to severe spastic cervical myeloradicular syndromes [average Nurick Score of 4]. Two-level [adjacent] cervical pathology [with retrovertebral extension], included disc disease [2 patients], spondyloarthrosis/stenosis [5 patients], ossification of the posterior longitudinal ligament [OPLL] [4 patients], and olisthy [2 patients]. Medical comorbidities included morbid obesity [5 patients], osteoporosis [5 patients], hypertension [5 patients], diabetes [3 patients], and coronary artery disease [2 patients]. Five patients underwent initial single level ACF consisting of two-level adjacent diskectomy with removal of the intervening vertebral body. Two patients originally underwent single level ACF alone and received hard cervico-thoracic orthoses [CTO]. The remaining 3 patients initially had simultaneous posterior fusions [PF] performed with halo immobilization [circumferential surgery]. The 3 patients undergoing initial circumferential surgery fused 4-8 months postoperatively. Two patients undergoing single level ACF alone, however, developed plate/graft extrusions one day and three weeks postoperatively. Both of these patients required secondary multilevel anterior corpectomy/fusion with posterior fusion and the application of a halo device. These latter patients fused within 7 and 9 postoperative months respectively. Odom’s criteria 1 year postoperatively revealed 2 excellent, 2 good, and 1 fair outcome. Conclusions: Morbidly obese patients undergoing single level ACF are at increased risk for plate/graft extrusion and should be considered candidates for initial simultaneous single-level ACF with posterior fusion and halo immobilization.