Corporectomy with and without bone graft for multilevel cervical spondylosis and ossification of the posterior longitudinal ligament

Multilevel cervical spondylotic myelopathy (CSM) and ossified posterior longitudinal ligament (OPLL) may be treated either by anterior decompression or by laminectomy. Only a few neurosurgeons are performing the former especially without a bone graft. Between 1991 and 1996, forty four patients underwent median cervical corpectomy of one to five segments. Twenty nine had CSM, four OPLL and rest mixed lesions. Median corpectomy was done by the Abe and Kojima method with a width of twelve to fifteen as with excision of posterior longitudinal ligament. No bone graft was placed in fifteen patients with gross spondylotic changes causing immobility demonstrated by preoperative dynamic studies. Eighty percent of patients, had an improvement of one grade or more on Harshʹs scale at a mean follow up of twenty five months. Eight percent remained same and five expired. Anterior decompression in CSM and OPLL appears to be a more physiological method with minimal cord manipulation to alleviate cord compression which is primarily anterior. Graft placement may not be necessary if segments are already fused because of extensive osteophyte formation, joint fusion, ligamentous fusion & DISH. Laminectomy though simple may lead to increase in posterior angulation of cord, kyphosis, scarring with adhesions along with persistence of the primary pathology. We conclude that anterior decompression leads to a more favourable outcome and mortality is due to poor prognostic indicators like old age, symptoms for more than one year, poor respiratory reserve and cord changes on MRI.