Anterior cervical decompression using the “Hybrid Decompression Fixation” technique, a combination of corpectomies and or discectomies, in the management of multilevel cervical myelopathy

In multilevel cervical myelopathy (MCM) the cord is compressed by soft and hard components, both at the discal level and behind the vertebral bodies. This may necessitate to perform multiple corpectomies in order to achieve adequate decompression. It is well known that multiple corpectomies are fraught with a high incidence of fixation failure. This may dictate the use of postoperative halo immobilization or the use of posterior laminoplasty for decompression. We opted the use of a “hybrid” technique for anterior decompression of 3-4 levels. This is combination of corpectomies and discectomies preserving a vertebral bridge in the area of the decompression for further anchorage of the cervical plate. We present our long term results using this technique. Reviewed 47 patients with MCM operated on with the hybrid method between 1999-2008. 24 had a 3 level surgery, 23 a 4 level decompression. Age ranged 46 to 83(mean 64). The 3L patients underwent 1 level corpectomy and single level discectomy. The 4L had either 1 level corpectomy and 2 level discectomy or 2 level corpectomy leaving a vertebral bridge the middle. All patients were instrumented using discal and vertebral body cages filled with autogenous local bone supplemented with an anterior dynamic plate to allow for postoperative subsidness. The plate was always attached with 2 screws to the vertebral bridge within the area of decompression. Operative time ranged between 2-4h. Only one patient deteriorated neurologically following surgery. All patients were placed only in a Philadelphia collar up to 6 weeks. Hospital stay ranged between 3-7 days (3.4). At follow up (15-84 months) neither hardware problems nor radiological pseudoarthroses were detected using flexion extension films. Satisfaction rate using the visual pain scale, showed marked reduction of cervical pain (from 51.12 to 1.81) only one patient reported increase of neck pain.. We have found the hybrid technique as a safe, well tolarated and efficient method for long anterior decompression of MCM.