European Spine Journal

, Volume 16, Issue 12, pp 2055–2071 | Cite as

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

  • Heiko Koller
  • Axel HempfingEmail author
  • Luis Ferraris
  • Oliver Maier
  • Wolfgang Hitzl
  • Peter Metz-Stavenhagen


In the future, there will be an increased number of cervical revision surgeries, including 4- and more-levels. But, there is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute to current knowledge, we want to share our experience with 4- and 5-level anterior cervical fusions in 26 cases in sight of a critical review of literature. At index procedure, almost 50% of our patients had previous cervical surgeries performed. Besides failed prior surgeries, indications included degenerative multilevel instability and spondylotic myelopathy with cervical kyphosis. An average of 4.1 levels was instrumented and fused using constrained (26.9%) and non-constrained (73.1%) screw-plate systems. At all, four patients had 3-level corpectomies, and three had additional posterior stabilization and fusion. Mean age of patients at index procedure was 54 years with a mean follow-up intervall of 30.9 months. Preoperative lordosis C2-7 was 6.5° in average, which measured a mean of 15.6° at last follow-up. Postoperative lordosis at fusion block was 14.4° in average, and 13.6° at last follow-up. In 34.6% of patients some kind of postoperative change in construct geometry was observed, but without any catastrophic construct failure. There were two delayed unions, but finally union rate was 100% without any need for the Halo device. Eleven patients (42.3%) showed an excellent outcome, twelve good (46.2%), one fair (3.8%), and two poor (7.7%). The study demonstrated that anterior-only instrumentations following segmental decompressions or use of the hybrid technique with discontinuous corpectomies can avoid the need for posterior supplemental surgery in 4- and 5-level surgeries. However, also the review of literature shows that decreased construct rigidity following more than 2-level corpectomies can demand 360° instrumentation and fusion. Concerning construct rigidity and radiolographic course, constrained plates did better than non-constrained ones. The discussion of our results are accompanied by a detailed review of literature, shedding light on the biomechanical challenges in multilevel cervical procedures and suggests conclusions.


Cervical spine Multilevel Fusion Instrumentation 



Anterior cervical plates


Anterior cervical plate stabilization


Anterior cervical (segmental) decompression/discectomy and fusion


Adjacent disc disease

CS- and NC-plate

Constrained and non-constrained screw-plate system


Cervicothoracic junction


Degenerative cervical instability


Lateral mass plating


Lateral mass constrained screw-rod system


Previous anterior cervical spine surgery


Recurrent laryngeal nerve


Titanium mesh cage(s)


Total cervical lordosis C2-7


  1. 1.
    AChen IH (1996) Biomechanical evaluation of subcorticl versus bicortical screw purchase in anterior cervical plating. Acta Neurchir 138:167–173Google Scholar
  2. 2.
    Abdulhak M, Marzouk S (2005) Challenging cases in spine surgery. Thime Med Publ, Inc, New York, pp 10–13Google Scholar
  3. 3.
    Anderson DG, Silber JS, Albert TJ (2005) Management of cervical kyphosis caused by surgery, degenerative disease, or trauma. In: Clark CR (ed) The cervical spine. Lippincott Williams & Wilkins, Philadelphia, pp 1135–1145Google Scholar
  4. 4.
    Arnold PM, Eckard DA (1999) Four-level anterior cervical discectomy and fusion report of 18 cases with one-year follow-up. Annual meeting CSRS-A, Podium Presentation #5Google Scholar
  5. 5.
    Ashkenazi E, Smorgick Y, Rand N, Millgram MA, Mirovsky Y, Floman Y (2005) Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique. J Neurosurg Spine 3:205–209PubMedGoogle Scholar
  6. 6.
    Barnes B, Haid RW, Rodts G, Subach B, Kaiser M (2002) Early results using atlantis anterior cervical plate system. Neurosurg Focus 12(1):Article 13Google Scholar
  7. 7.
    Bayley JC, Yoo JU, Kruger DM, Schlegel J (1995) The role of distraction in improving the space available for the cord in cervical spondylosis. Spine 20:771–775PubMedGoogle Scholar
  8. 8.
    Bernard TN Jr, Whitecloud TS III (1987) Cervical spondylotic myelopathy and myeloradiculopathy: anterior decompression and stabilization with autogenous fibula strut graft. Clin Orthop Rel Res 221:149–160Google Scholar
  9. 9.
    Beutler WJ, Sweeney CA, Conolly PJ (2001) Recurrent laryngeal nerve injury with anterior cervical spine surgery risk with laterality of surgical approach. Spine 26:1337–1342PubMedGoogle Scholar
  10. 10.
    Bilsky MH, Boakye M, Collignon F, Kraus D, Boland P (2005) Operative management of metastatic and malignant primary subaxial cervical tumors. J Neurosurg Spine 2:256–264PubMedGoogle Scholar
  11. 11.
    Blauth M, Schmidt U, Bastian C, Knop C, Tscherne H (1998) Die ventrale interkorporelle Spondylodese bei Verletzungen der Halswirbelsäule. Indikationen, Operationstechnik und Ergebnisse. Zentralbl Chir 123:919–929PubMedGoogle Scholar
  12. 12.
    Bolesta MJ, Rechtine DR II, Chrin AM (2000) Three- and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine 25:2040–2056PubMedGoogle Scholar
  13. 13.
    Bose B (2003) Anterior cervical arthrodesis using DOC dynamic stabilization implant for improvement in sagittal angulation and controlled settling. J Neurosurg 98(1 Suppl):8–13PubMedGoogle Scholar
  14. 14.
    Bozkus H, Ames CP, Chamberlain RH, Nottmeier EW, Sonntag VKH, Papadopoulos SM, Crawford NR (2005) Biomechanical analysis of rigid stabilization techniques for three-column injury in the lower cervical spine. Spine 30:915–922PubMedGoogle Scholar
  15. 15.
    Brodke DS, Gollogly S, Alexander MR, Nguyen BK, Dailey AT, Bachus AK (2001) Dynamic cervical plates: biomechanical evaluation of load sharing and stiffness. Spine 26:1324–1329PubMedGoogle Scholar
  16. 16.
    Brodsky AE, Khalil MA, Sassard WR, Newman BP (1992) Repair of symptomatic pseudoarthrosis of anterior cervical fusion: posterior versus anterior repair. Spine 17:1137–1143PubMedGoogle Scholar
  17. 17.
    Bryan C, Cordista AG, Horodyski M, Rechtine GR (2005) Biomechanical evaluation of the pullout strength of cervical screws. J Spinal Disord 18:506–510Google Scholar
  18. 18.
    Carreon L, Glassman SD, Campbell MJ (2006) Treatment of anterior cervical pseudoarthrosis: posterior fusion versus anterior revision. Sine J 6:154–156Google Scholar
  19. 19.
    Casha S, Fehlings MG (2003) Clinical and radiological evaluation of the Codman semiconstrained load-sharing anterior cervical plate: prospective multicenter trial and independent blinded evaluation of outcome. J Neurosurg 99(3 Suppl):264–270PubMedGoogle Scholar
  20. 20.
    Coe JD, Vaccaro AR (2004) Complications of anterior cervical plating. In: Clark CR (eds) The cervical spine, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1147–1169Google Scholar
  21. 21.
    Conrad B, Cordista A, Horodyski MB, Rechtine G (2005) Biomechanical evaluation of the pullout strenght of cervical screws. J Spinal Disord Tech 18:506–510PubMedGoogle Scholar
  22. 22.
    Curylo L, An HS (2005) Spinal instrumentation on degenerative disorders of the cervical spine, 2nd edn. Lippincott Williams&Wilkins, PhiladelphiaGoogle Scholar
  23. 23.
    Daubs MD (2005) Early failures following cervical corpectomy reconstrcution with titanium mesh cages and anterior plating. Spine 30:1402–1406PubMedGoogle Scholar
  24. 24.
    Do Koh Y, Lim TH, Won You J, Eck J, An HS (2001) A biomechanical comparison of modern anterior and posterior plate fixation of the cervical spine. Spine 26:15–21PubMedGoogle Scholar
  25. 25.
    Dorai Z, Morgan H, Cimbra C (2003) Titanium cage reconstruction after cervical corpectomy. J Neurosurg 99(1 Suppl):3–7PubMedGoogle Scholar
  26. 26.
    DR Gore (2001) The arthrodesis rate in multilevel anterior cervical fusions using autogenous fibula. Spine 26:1259–1263Google Scholar
  27. 27.
    DuBois CM, Bolt PM, Todd AG, Gupta P, Wtzel FT, Phillips FM (2007) Static versus dynamic plating for multileve lanterior cervical discectomy and fusion. Spine J 7:188–193PubMedGoogle Scholar
  28. 28.
    Eleraky MA, Llanos C, Sonntag VKH (1999) Cervical corpectomy: report of 185 cases and review of literature. J Neurosurg 90(1 Suppl):35–41PubMedGoogle Scholar
  29. 29.
    Elsaghir H, Bohm H (2000) Anterior versus posterior cervical plating in cervical corpectomy. Arch Orthop Trauma Surg 120:549–554PubMedGoogle Scholar
  30. 30.
    Epstein NE (2003) Anterior cervical dynamic ABC plating with single level corpectomy and fusion in forty-two patients. Spinal Cord 41:153–158PubMedGoogle Scholar
  31. 31.
    Epstein NE (2002) Reoperation rates for acute graft extrusion and pseudarthrosis after one-level anterior corpectomy and fusion with and without plate instrumentation: etiology and corrective management. Surg Neurol 56:73–80Google Scholar
  32. 32.
    Ferch RD, Shad Amjad, Cadoux-Hudson TAD, Teddy PJ (2004) Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg 100(1 Suppl Spine):13–19PubMedGoogle Scholar
  33. 33.
    Foley KT, Di Angelo DJ, Rampersaud YR, Vossel KA, Jansen TH (1999) The in vitro effects of instrumentation on multilevel cervical strut-graft mechanics. Spine 24:2366–2376PubMedGoogle Scholar
  34. 34.
    Foley KT, Smith MM, Wiles DA (1997) Anterior cervical plating does not prevent strut graft displacement in multilevel cervical corpectomy. In: Annual meeting of the CSRS-A. Rancho Mirage, California, Paper presentationGoogle Scholar
  35. 35.
    Gallagher MR, Maiman DJ, Reinartz J Pintar F, Yoganandan N (1993) Biomechanical evaluation of Caspar cervical screws: Comparative study under cyclic loading. Neurosurgery 33:1045–1050; Comments 1050–1051Google Scholar
  36. 36.
    Geisler FH, Caspar W, Pitzen T et al (1998) Reoperation in patients after anterior cervical plate stabilization in degenerative disease. Spine 23:911–920PubMedGoogle Scholar
  37. 37.
    Gonugunta V, Krishnaney AA, Benzel EC (2005) Anterior cervical plating. Neurol India 53:424–432PubMedCrossRefGoogle Scholar
  38. 38.
    Gore DR, Sepic SB, Gardner GM (1986) Roentgenographic findings of the cervical spine in asymptomatic people. Spine 11:521–524PubMedGoogle Scholar
  39. 39.
    Greene DL, Crawford NR, Chamberlain RH, Park SC, Crandall D (2003) Biomechanical comparison of cervical interbody cage versus structural bone graft. Spine J 3:262–269PubMedGoogle Scholar
  40. 40.
    Greiner-Perth R, Allam Y, El-shagir H, Frank J, Boehm H (2006) Analysis of reoperations after surgical treatment of degenerative cervical spine disorders. A report on 900 cases. Eur Spine J 15(Suppl 4):S459Google Scholar
  41. 41.
    Grob D, Frauenfelder H, Mannion AF (2006) The association between cervical spine curvature and neck pain. Eur Spine J, E-pub Octob 2006Google Scholar
  42. 42.
    Hardacker JW, Shuford RF, Capicotto PN, Pryor PW (1997) Radiographic stanting cervical segmental alignement in adult volunteers without neck symptoms. Spine 22:1472–1480PubMedGoogle Scholar
  43. 43.
    Harrison DD, Harrison DE, Janik TJ, Cailliet R, Ferrantelli JR, Haas JW, Holland B (2004) Modeling of the sagittal cervical spine as a method to discriminate hypolordosis. Spine 29:2485–2492PubMedGoogle Scholar
  44. 44.
    Harrison DD, Janik TJ, Troyanovich SJ, Holland B (1996) Comparisons of Lordotic cervical spine curvatures to a theoretical model of the static sagittal cervical spine. Spine 21:667–675PubMedGoogle Scholar
  45. 45.
    Harrison DE Harrison DD, Janik Tj, Jones WE, Calliet R, Normand M (2001) Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine. Clin Biomech 16:276–284Google Scholar
  46. 46.
    Harrop JS, Steinmetz MP, Benzel EC (2005) Deformity surgery: subaxial cervical spine. In: Benzel EC (ed) Spine surgery. Elsevier, Philadelphia, pp 876–891Google Scholar
  47. 47.
    Hart R, Gillard J, Prem S, Shea M, Kitchel S (2005) Comparison of stiffness and failure load of two cervical spine fixation techniques in an in vitro human model. J Spinal Disord Tech 18:S115–118PubMedGoogle Scholar
  48. 48.
    Hee HT, Majd ME, Holt RT, Whitecloud TS III, Pemkowski D (2003) Complications of multilevel cervical corporectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord Tech 16:1–9PubMedGoogle Scholar
  49. 49.
    Herrmann AM, Geisler FH (2004) Geometric results of anterior cervical plate stabilization in degenerative disease. Spine 29:1226–1234PubMedGoogle Scholar
  50. 50.
    Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion. Spine J 4:190S–194SPubMedGoogle Scholar
  51. 51.
    Hitchon PW, Brenton MD, Coppes JK, From AM, Torner JC (2003) Factors affecting pullout strength of self-drilling and self-tapping anterior cervical screws. Spine 28:9–13PubMedGoogle Scholar
  52. 52.
    Ikenaga M, ShikataJ, Tanaka C (2005) Anterior corpectomy and fusion with fibular strut grafts for multilevel cervical myelopathy. J Neurosurg Spine 3:79–85PubMedGoogle Scholar
  53. 53.
    Isomi T, Panjabi MM, Wang JL, Vaccaro AR, Garfin SR, Patel T (1999) Stabilizing potential of anterior cervical plates in multilevel corpectomies. Spine 24:2219–2223PubMedGoogle Scholar
  54. 54.
    Isomi T Panjabi MM, Wang JL et al (1999) Stabilizing potential of anterior cervical plates in multilevel corporectomies. Spine 24:2219–2223Google Scholar
  55. 55.
    Jeffrey D, Vaccaro C, Vaccaro AR (2004) Complications of anterior cervical plating. In: Clark CR (eds) The cervical spine. 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1147–1169Google Scholar
  56. 56.
    Jones EL, Heller JG, Silcox DH, Hutton WC (1997) Cervical pedicle screws versus lateral mass screws: anatomic feasibility and biomechanical comparison. Spine 22:977–982PubMedGoogle Scholar
  57. 57.
    Katsuura A, Hukuda S, Imanaka T, Miyamoto K, Kanemoto M (1996) Anterior cervical plate used in degenerative disease can maintain cervical lordosis. J Spinal Disord 9:470–476PubMedGoogle Scholar
  58. 58.
    Kotani Y, Cunningham BW, Abumi K, McAfee PC (1994) Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine. Spine 19:2529–2539PubMedGoogle Scholar
  59. 59.
    Kothe R, Rüter W, Schneider E, Linke B (2004) Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine 29:1869–1875PubMedGoogle Scholar
  60. 60.
    Kreshak JL, Kim DH, Lindsey DP, Kam AC, Panjabi MM, Yerby SA (2002) Posterior stabilization at the cervicothoracic junc-tion: a biomechanical study. Spine 27:2763–2770PubMedGoogle Scholar
  61. 61.
    Krikpatrick JS, Levy JA, Carillo J, Moeini SR (1999) Reconstruction after multilevel corporectomy in the cervical spine. A sagittal plane biomechanical study. Spine 24:1186–1191, Discussion 1191Google Scholar
  62. 62.
    Le H, Balabhadra R, Park J, Kim D (2003). Surgical treatment of tumors involving the cervicothoracic junction. Neurosurg Focus 15(5):Article 3Google Scholar
  63. 63.
    Lee JY, Lim MR, Albert TJ (2005) Dysphagia after anterior cervical spine surgery: pathophysiology, incidence, and prevention. www.csrs.orgGoogle Scholar
  64. 64.
    Lehmann W, Briem D, Blauth M, Schmidt U (2005) Biomechanical comparison of anterior cervical spine locked and unlocked plate-fixation systems. Eur Spine J 14:243–249PubMedGoogle Scholar
  65. 65.
    Liu JK, Apfelbaum RI, Chiles III BW, Schmidt MH (2003) Cervical spinal metastasis: anterior reconstruction and stabilization techniques after tumor resection. Neurosurg Focus 15(5):Article 2Google Scholar
  66. 66.
    Lower GL, Swank ML, McDonough RF (1995) Surgical revision for failed anterior cervical fusions. Articular pillar plating or anterior revision? Spine 20:2436–2441CrossRefGoogle Scholar
  67. 67.
    Lowery GL, McDonough RF (1998) The significance of hardware failure in anterior cervical plate fixation. Patients with 2- to 7-year follow-up. Spine 23:181–186PubMedGoogle Scholar
  68. 68.
    MacDonald RL, Fehlings MG, Tator CH, Lozano A, Fleming JR, Gentili F, Bernstein M, Wallace MC, Tasker RR (1997) Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86:990–997PubMedCrossRefGoogle Scholar
  69. 69.
    Maiman DJ, Pintar FA, Yoganandan N, Reinartz J, Toselli R, Woodward E, Haid R (1992) Pull-out strenght of Caspar cervical screw. Neurosurg 31:1097–1101Google Scholar
  70. 70.
    Majd ME, Vadhva M, Holt RT (1999) Anterior reconstruction using titanium cages with anterior plating. Spine 24:1604–1610PubMedGoogle Scholar
  71. 71.
    Mayr MT, Subach BR, Comey CH, Rodts GE, Haid RW Jr (2002) Cervical spinal stenosis: outcome after anterior corpectomy, allograft reconstruction, and instrumentation. J Neurosurg (Spine 1) 96:10–16Google Scholar
  72. 72.
    Mc Aviney J, Schulz D, Bock R, Harrison DE, Holland B (2005) Determining the relationship between cervical lordosis and neck complaints. J Manupulative Physiol Ther 28:187–193Google Scholar
  73. 73.
    McAfee PC Bohlmann HH, Ducker TB et al (1995) One stage anterior cervical decompression and posterior stabilization. J Bone Joint Surg 77-A:1791–1800Google Scholar
  74. 74.
    Metz-Stavenhagen P, Krebs S, Meier O (2001) Cervical fractures in ankylosing spondylitis. Orthopaede 30:925–931Google Scholar
  75. 75.
    Mummaneni PV, Haid RW, Traynelis VC, Sasso RC, Subach BR, Fiore AJ, Rodts GE (2002) Posterior cervical fixation using a new polyaxial screw and rod system: technique and surgical results. Neurosurg Focus 12:1/Article 8Google Scholar
  76. 76.
    Naideri S, Baldwin NG (2005) Ventral cervical decompression and fusion: To plate. In: Benzel EC (ed) Spinal surgery. Elsevier, Philadelphia, pp 2061–2064Google Scholar
  77. 77.
    Nakase H, Park Y-S, Kimura H, Sakaki T, Morimoto T (2006) Complications and long-term follow-up results in titanium mesh cage reconstruction after cervical corpectomy. J Spinal Disord Tech 19:353–357PubMedGoogle Scholar
  78. 78.
    Epstein NE (2003) Anterior cervical dynamic ABC plating with single level corprorectomy and fusion in forty-two patients. Spinal Cord 41:153–158PubMedGoogle Scholar
  79. 79.
    Nieto JH, Benzel EC (2005) Combined ventral-dorsal procedure. In: Benzel EC (eds). Spine surgery. 2nd edn. Elsevier, Philadelphia, pp 402–405Google Scholar
  80. 80.
    Nirala AP, Husain M, Vatsal DK (2004) A retrospective study of multiple interbody grafting and long segment strut grafting following anterior cervical decompression. Br J Neurosurg 18:227–232PubMedGoogle Scholar
  81. 81.
    Nojiri K, Matsumoto M, Chiba K, Maruiwa H, Nakamura M, Nishizawa T, Toyama Y (2003) Relationship between alignement of upper and lower cervical spine in asymptomatic individuals. J Neurosurg (Spine 1) 99:80–81Google Scholar
  82. 82.
    Nolan JP, Sherk HH (1988) Biomechanical evaluation of the extensor musculatur of the cervicle spine. Spine 13:9PubMedGoogle Scholar
  83. 83.
    Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100PubMedGoogle Scholar
  84. 84.
    Odom Gl, Finney W, Woodhall B (1958) Cervical disk lesions. JAMA 166:23–28Google Scholar
  85. 85.
    Ohnari H, Sasai K, Akagi S, Iida H, Takanori S, Kato I (2006) Investigation of axial symptoms after cervical laminoplasty, using questionnaire survay. Spine J 6:221–227PubMedGoogle Scholar
  86. 86.
    Panjabi MM, Isomi T, Wang JL (1999) Loosening at the screw-vertebra junction in multilevel anterior cervical plate constructs. Spine 24:2383–2388PubMedGoogle Scholar
  87. 87.
    Pitzen T, Barbier D, Tintinger F, Steudel WI, Strowitzki M (2002) Screw fixation to the posterior cortical shell does not influence peak torque and pullout in anterior cervical plating. Eur Spine J 11:494–499PubMedGoogle Scholar
  88. 88.
    Porter RW Crawford NR, Chamberlain RH, Park SC, Detwiler PW, Apostolides PJ, Sonntag VKH (2003) Biomechanical analysis of multilevel cervical corporectomy and plate constructs. J Neurosurg (Spine 1) 99:98–103Google Scholar
  89. 89.
    Rao RD, Gourab K, David KS (2006) Operative treatment of cervical spondylotic myelopathy. J Bone Joint Surg 88-A:1619–1640Google Scholar
  90. 90.
    Sasso RC (2004) Salvage of long strut graft failure following multilevel cervical corporectomy and arthrodesis. In: CR Clark (eds) The cervical spine, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1212–1217Google Scholar
  91. 91.
    Riew KD, Hilibrand AS, Palumbo MA, Bohlmann HH (1999) Anterior cervical corpectomy in patients previously managed with a laminectomy: short-term complications. J Bone Joint Surg Am 81-A:950–957Google Scholar
  92. 92.
    Rogers DE, McDonough P, Cortes Z, Delamarter R (2001) Combined anterior and posterior fusions in patients requiring 3 or more cervical vertebrectomies. In: Annual meeting CSRS-A, Poster #28Google Scholar
  93. 93.
    Ryken TC, Goel VK, Clausen JD, Traynelis VC (1995) Assessment of unicortical and bicortical fixation in a quasistatic cadaveric model. Role of bone mineraly density and screw torque. Spine 20:1861–1867PubMedGoogle Scholar
  94. 94.
    Sasso RC (2004) Salvage of long strut graft failure following multilevel cervical corporectomy and arthrodesis. In: Clark CR (eds) The cervical spine, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1212–1217Google Scholar
  95. 95.
    Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV (2003) Early reconstruction failures after multilevel cervical corpectomy. Spine 28:140–142PubMedGoogle Scholar
  96. 96.
    Saunders RL, Pikus HJ, Ball P (1998) Four-level cervical corpectomy. Spine 23:2455–2461PubMedGoogle Scholar
  97. 97.
    Ludwig SC (2004) Complications of cervical spine pedicle screw placement. In: Clark CR (ed) The cervical spine. 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1186–1192Google Scholar
  98. 98.
    Schlenk RP, Stewart T, Benzel EC (2003) The biomechanics of iatrogenic spinal destabilization and implant failure. Neurosurg Focus 15(3):Article 2Google Scholar
  99. 99.
    Schmidt R, Wilke HJ, Claes L, Puhl W, Richter M (2005) Effect of constrained posterior screw and rod systems for primary stability: Biomechanical in vitro comparison of various instrumentations in a single-level corporectomy model. Eur Spine J 14:372–380PubMedGoogle Scholar
  100. 100.
    Schmidt R, Wilke HJ, Claes L, Puhl W, Richter M (2003) Pedicle screws enhance primary stability in multilevel cervical corporectomies: biomechanical in vitro comparison of different implants including constrained and nonconstrained posterior instruments. Spine 16:1821–1828Google Scholar
  101. 101.
    Schultz KD Jr, McLaughlin MR, Haid RW Jr, Comey CH, Rodts GE Jr, Alexander J (2000) Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders. J Neurosurg 93(Suppl 2):214–221PubMedGoogle Scholar
  102. 102.
    Schulz KD Jr McLaughlin MR, Haud RW Jr et al (2000) Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders. J Neursurg 93(Suppl 2):214–221Google Scholar
  103. 103.
    Sevki K, Mehmet T, Azmi H, Mercan S, Erkal B (2004) Results of surgical treatment for degenerative cervical myelopathy. Spine 29:2493–2500PubMedGoogle Scholar
  104. 104.
    Singh K, Vaccaro AR, Kim J, Lorenz EP, Lim TH, An HS (2003) Biomechanical comparison of cervical spine reconstructive techniques after a multilevel corpectomy of the cervical spine. Spine 28:2352–2357; Riew KD point of view p2358Google Scholar
  105. 105.
    Singh K, Vaccaro AR, Kim J, Lorenz EP, Lim TH, An HS (2004) Enhancement of stability following anterior cervical corporectomy: a biomechanical study. Spine 29:845–849PubMedGoogle Scholar
  106. 106.
    Smith DA, Melton DM, Cahill DW (2005) Interbody cages. In: Benzel EC (ed) Spinal surgery. Elsevier, Philadelphia, pp 378–386Google Scholar
  107. 107.
    Smith PN, Hank SE, Knaub MA, Kang JD (2003) Fibular strut complications of multi-level, non-instrumented cervical corpectomy and fusion: a consecutive series of 209 patients. In: Annual meeting CSRS-A, Podium presentation #’13Google Scholar
  108. 108.
    Spivak JM, Chen D, Kummer FJ (1999) The effect of locking fixation screws on the stability of anterior cervical plating. Spine 24:334–338PubMedGoogle Scholar
  109. 109.
    Steinmetz MP, Kager C, Vaccaro AR, Benzel EC (2005) Kyphotic cervical deformity correction. In: Benzel EC (eds) Spine surgery. 2nd edn. Elsevier, Philadelphia, pp 788–795Google Scholar
  110. 110.
    Steinmetz MP, Kager CD, Benzel EC (2002) Ventral correction of postsurgical cervical kyphosis. J Neurosurg (Spine 2) 97:1–7CrossRefGoogle Scholar
  111. 111.
    Steinmetz MP, Warbel A, Whitfield M, Bingaman W (2002) Preliminary experience with the DOC dynamic cervical implant for the treatment of multilevel cervical spondylosis. J Neurosurg (Spine 3) 97:330–336Google Scholar
  112. 112.
    Stewart TJ, Steinmety MP, Benzel EC (2005) Technique for the ventral correction of postsurgical cervical kyphotic deformity. Neurosurgery 56(1 Suppl):191–195PubMedGoogle Scholar
  113. 113.
    Suda K, Abumi K, Ito M, Shono Y, Kaneda K, Fujiya M (2003) Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine 28:1258–1262PubMedGoogle Scholar
  114. 114.
    Swank ML, Lowery GL, Bhat AL, McDonough RF (1997) Anterior cervical allograft arthrodesis and instrumentation: multiple interbody grafting or strut graft reconstruction. Eur Spine J 6:138–143PubMedGoogle Scholar
  115. 115.
    Thongtrangan I, Balabhadra RSV, Kim DH (2003) Management of strut graft failure in anterior cervical spine surgery. Neurosurg Focus 15(3):Article 4CrossRefGoogle Scholar
  116. 116.
    Ulrich C, Arand M, nothwang J (2001) Internal fixation on the lower cervical spine—biomechanics and clinical practice of procedures and implants. Eur Spine J 10:88–100PubMedGoogle Scholar
  117. 117.
    Vaccaro AR, Falatyn SP, Scuderi GJ, Eismont FJ, McGuire RA, Singh K, Garfin SR (1998) Early failure of a long segment anterior plate fixation. J Spinal Disord 11:410–415PubMedGoogle Scholar
  118. 118.
    Vanichkachorn JS, Vaccaro AR, Silveri CP, Albert TJ (1998) Anterior junctional plate in the cervical spine. Spine 23:2462–2467PubMedGoogle Scholar
  119. 119.
    Vecsei V, Fuchs M, Gäbler Ch (1998) Indication of severe unstable injuries of the cervical spine by combined anterior and posterior internal fixation. Osteos Int 6:121–128Google Scholar
  120. 120.
    Vesel M, Straus I, Al Mawed S, Dobravec M, Jug M (2006) Angular stable plates in lower cervical spine fractures. Osteo Trauma Care 14:22–27Google Scholar
  121. 121.
    Wang JC, Hart RA, Emery SE, Bohlmann HH (2003) Graft migration or displacement after multilevel cervical corpectomy and strut grafting. Spine 28:1016–1021PubMedGoogle Scholar
  122. 122.
    Wang MC, Chan L, Maiman DJ, Kreuter W, Deyo RA (2007) Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine 32:342–347PubMedGoogle Scholar
  123. 123.
    Woiciechowsky C (2005) Distractable vertebral cages for reconstruction after cervical corpectomy. Spine 30:1736–1741PubMedGoogle Scholar
  124. 124.
    Zdeblick T, Bohlmann H (1989) Cervical kyphosis and myelopathy treatment by anterior corpectomy and strut grafting. J Bone Joint Surg 71-Am:170–182Google Scholar
  125. 125.
    Zdichavsky M, Blauth M, Knop C, Lange U, Krettek C, Bastian L (2005) Ankylosing spondylitis therapy and complications of 34 spine fractures. Chirurg 76:967–976PubMedGoogle Scholar
  126. 126.
    Zoega B, Karrholm J, Lind B (1998) Plate fixation adds stability to two-level anterior fusion in the cervical spine: a randomized study using radiostereometry. Eur Spine J 7:302–307PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Heiko Koller
    • 1
    • 3
  • Axel Hempfing
    • 1
    Email author
  • Luis Ferraris
    • 1
  • Oliver Maier
    • 1
  • Wolfgang Hitzl
    • 2
  • Peter Metz-Stavenhagen
    • 1
  1. 1.German Scoliosis CenterBad WildungenHessenGermany
  2. 2.Paracelsus Medical University, Research Office, Biostatistics, SalzburgSalzburgAustria
  3. 3.Katharinenhospital StuttgartStuttgartGermany

Personalised recommendations