Multilevel ACDF Versus Corpectomy

  • Hani R. Malone
  • Michael G. Kaiser


Anterior approaches to the cervical spine are routinely used to treat degenerative cervical spondylosis, as well as traumatic, neoplastic, and infectious pathologies. Improved clinical outcomes following the two most common procedures, anterior cervical discectomy and fusion (ACDF) and cervical corpectomy, are well established in the literature. Both techniques can be effectively used to alleviate pain and improve function by decompressing the neural elements and restoring stability and alignment to the cervical spine. However, there are inherent advantages and disadvantages associated with each technique that may favor ACDF or corpectomy in a given case. In this chapter, we will discuss anterior approaches to multilevel cervical pathology, including indications, surgical strategy, and technique. The advantages and disadvantages of cervical corpectomy will be compared and contrasted with multilevel ACDF. Special attention will be paid to a growing body of evidence that supports the use of a hybrid approach in select clinical scenarios, which incorporates both ACDF and corpectomy in a single construct.


Anterior approaches Cervical spine Degenerative cervical spondylosis ACDF Cervical corpectomy 


  1. 1.
    Mummaneni PV, Kaiser MG, Matz PG, et al. Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg Spine. 2009;11(2):130–41.CrossRefGoogle Scholar
  2. 2.
    Komotar RJ, Mocco J, Kaiser MG. Surgical management of cervical myelopathy: indications and techniques for laminectomy and fusion. Spine J. 2006;6(6 Suppl):252S–67S.CrossRefGoogle Scholar
  3. 3.
    Kaiser MG. Multilevel cervical spondylosis. Neurosurg Clin N Am. 2006;17(3):263–275, vi.CrossRefGoogle Scholar
  4. 4.
    Lau D, Chou D, Mummaneni PV. Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes. J Neurosurg Spine. 2015;23(3):280–9.CrossRefGoogle Scholar
  5. 5.
    Masaki Y, Yamazaki M, Okawa A, et al. An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament: anterior decompression with spinal fusion versus laminoplasty. J Spinal Disord Tech. 2007;20(1):7–13.CrossRefGoogle Scholar
  6. 6.
    Matz PG, Holly LT, Groff MW, et al. Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy. J Neurosurg Spine. 2009;11(2):174–82.CrossRefGoogle Scholar
  7. 7.
    Matz PG, Holly LT, Mummaneni PV, et al. Anterior cervical surgery for the treatment of cervical degenerative myelopathy. J Neurosurg Spine. 2009;11(2):170–3.CrossRefGoogle Scholar
  8. 8.
    Swank ML, Lowery GL, Bhat AL, McDonough RF. Anterior cervical allograft arthrodesis and instrumentation: multilevel interbody grafting or strut graft reconstruction. Eur Spine J. 1997;6(2):138–43.CrossRefGoogle Scholar
  9. 9.
    Joaquim AF, Murar J, Savage JW, Patel AA. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J. 2014;14(9):2246–60.CrossRefGoogle Scholar
  10. 10.
    Ghogawala Z, Martin B, Benzel EC, et al. Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy. Neurosurgery. 2011;68(3):622–30. discussion 630-621.CrossRefGoogle Scholar
  11. 11.
    Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV. Early reconstruction failures after multilevel cervical corpectomy. Spine (Phila Pa 1976). 2003;28(2):140–2.CrossRefGoogle Scholar
  12. 12.
    Etame AB, Wang AC, Than KD, La Marca F, Park P. Outcomes after surgery for cervical spine deformity: review of the literature. Neurosurg Focus. 2010;28(3):E14.CrossRefGoogle Scholar
  13. 13.
    Grosso MJ, Hwang R, Mroz T, Benzel E, Steinmetz MP. Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery. J Neurosurg Spine. 2013;18(6):537–44.CrossRefGoogle Scholar
  14. 14.
    Traynelis VC. Total subaxial reconstruction. J Neurosurg Spine. 2010;13(4):424–34.CrossRefGoogle Scholar
  15. 15.
    Hilibrand AS, Fye MA, Emery SE, Palumbo MA, Bohlman HH. Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression. Spine (Phila Pa 1976). 2002;27(2):146–51.CrossRefGoogle Scholar
  16. 16.
    Pitzen TR, Chrobok J, Stulik J, et al. Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two-year results of a multi-centric, randomized, controlled study. Spine (Phila Pa 1976). 2009;34(7):641–6.CrossRefGoogle Scholar
  17. 17.
    Ghahreman A, Rao PJ, Ferch RD. Dynamic plates in anterior cervical fusion surgery: graft settling and cervical alignment. Spine (Phila Pa 1976). 2009;34(15):1567–71.CrossRefGoogle Scholar
  18. 18.
    Kelly MP, Mok JM, Berven S. Dynamic constructs for spinal fusion: an evidence-based review. Orthop Clin North Am. 2010;41(2):203–15.CrossRefGoogle Scholar
  19. 19.
    Fraser JF, Hartl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine. 2007;6(4):298–303.CrossRefGoogle Scholar
  20. 20.
    Heary RF, Schlenk RP, Sacchieri TA, Barone D, Brotea C. Persistent iliac crest donor site pain: independent outcome assessment. Neurosurgery. 2002;50(3):510–6. discussion 516-517.PubMedGoogle Scholar
  21. 21.
    Ryken TC, Heary RF, Matz PG, et al. Techniques for cervical interbody grafting. J Neurosurg Spine. 2009;11(2):203–20.CrossRefGoogle Scholar
  22. 22.
    Singh K, Vaccaro AR, Kim J, Lorenz EP, Lim TH, An HS. Biomechanical comparison of cervical spine reconstructive techniques after a multilevel corpectomy of the cervical spine. Spine (Phila Pa 1976). 2003;28(20):2352–8. discussion 2358.CrossRefGoogle Scholar
  23. 23.
    Singh K, Vaccaro AR, Kim J, Lorenz EP, Lim TH, An HS. Enhancement of stability following anterior cervical corpectomy: a biomechanical study. Spine (Phila Pa 1976). 2004;29(8):845–9.CrossRefGoogle Scholar
  24. 24.
    Porter RW, Crawford NR, Chamberlain RH, et al. Biomechanical analysis of multilevel cervical corpectomy and plate constructs. J Neurosurg. 2003;99(1 Suppl):98–103.PubMedGoogle Scholar
  25. 25.
    Ashkenazi E, Smorgick Y, Rand N, Millgram MA, Mirovsky Y, Floman Y. Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique. J Neurosurg Spine. 2005;3(3):205–9.CrossRefGoogle Scholar
  26. 26.
    Liu JM, Peng HW, Liu ZL, Long XH, Yu YQ, Huang SH. Hybrid decompression technique versus anterior cervical corpectomy and fusion for treating multilevel cervical spondylotic myelopathy: which one is better? World Neurosurg. 2015;84(6):2022–9.CrossRefGoogle Scholar
  27. 27.
    Hussain M, Nassr A, Natarajan RN, An HS, Andersson GB. Corpectomy versus discectomy for the treatment of multilevel cervical spine pathology: a finite element model analysis. Spine J. 2012;12(5):401–8.CrossRefGoogle Scholar
  28. 28.
    Wei-bing X, Wun-Jer S, Gang L, Yue Z, Ming-xi J, Lian-shun J. Reconstructive techniques study after anterior decompression of multilevel cervical spondylotic myelopathy. J Spinal Disord Tech. 2009;22(7):511–5.CrossRefGoogle Scholar
  29. 29.
    Kaminsky SB, Clark CR, Traynelis VC. Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at five year average follow-up. Iowa Orthop J. 2004;24:95–105.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Apfelbaum RI, Kriskovich MD, Haller JR. On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery. Spine (Phila Pa 1976). 2000;25(22):2906–12.CrossRefGoogle Scholar
  31. 31.
    Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 2002;50(2):229–36. discussion 236-228.PubMedGoogle Scholar
  32. 32.
    Shaffer WO, Baisden JL, Fernand R, Matz PG. North American Spine S. An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery. Spine J. 2013;13(10):1387–92.CrossRefGoogle Scholar
  33. 33.
    Kelleher MO, Tan G, Sarjeant R, Fehlings MG. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine. 2008;8(3):215–21.CrossRefGoogle Scholar
  34. 34.
    Heeneman H. Vocal cord paralysis following approaches to the anterior cervical spine. Laryngoscope. 1973;83(1):17–21.CrossRefGoogle Scholar
  35. 35.
    Holly LT, Matz PG, Anderson PA, et al. Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy. J Neurosurg Spine. 2009;11(2):112–8.CrossRefGoogle Scholar
  36. 36.
    Benzel EC. Complex Instrumentation Constructs and Force Application. In: Benzel EC, editor. Biomechanics of spine stabilization. Rolling Meadows: AANS Publications Committee; 2001.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Neurological Surgery,Columbia University Medical CenterNew YorkUSA

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