Neurosurg. Rev. 20(1997) 25~1 Corpectomy for multi-level cervical spondylosis and ossification of the posterior longitudinal ligament Deepu Banerji, Rajesh Acharya, Sanjay Behari, Devendra K. Chhabra, and Vijen- dra K. Jain Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Abstract The choice of a surgical approach for multi-levelcervical spondyloticmyelopathy(CSM) and ossificationof the po- sterior longitudinal ligament (OPLL) is still a controversial issue. While most of the surgeons are still performing de- compression by laminectomy, some are doing multi-level anterior decompression. Few neurosurgeons are perfor- mingdecompression by corpectomy.Wehavetreated 26 pa- tients by median cervical corpectomy during the last 4 years. These patients were followed up for a mean period of 25 months. Twentyone (80%) patients had a good out- come, 2 patients remained unchanged and 3 expired. Re- viewof the literature and our experienceindicatesthat pa- tients with CSM and OPLL should be operated by median cervical corpectomy (anterior approach). Keywords: Cervical spondylosis,corpectomy, myelopathy, ossification of the posterior longitudinal ligament, verte- brectomy. 1 Introduction Over the past decade, anterior decompression of the cervical cord has been considered more effective than conventional laminectomy for multi level cer- vical disc disease, cervical spondylosis and ossifica- tion of the posterior longitudinal ligament (OPLL) [2, 10, 12, 16, 24]. Although decompression of the cord by laminectomy results in clinicalimprovement in some patients, many of them deteriorate due to persistence of anterior compression, increase in po- sterior angulation of the cord, kyphotic deformity or posterior scarring & adhesions [4, 6, 15]. Hence we approached by attacking the site of compression di- rectly and removing the compressive element by me- dian corpectomy and performing a bony fusion. However, in six cases (23%) with gross spondylotic changes causing immobility in the involved seg- ments, we did not put any graft. We report the results of anterior cervical corpec- tomy for myelopathy caused by multi-level cervical spondylosis, OPLL and combined lesions in 26 con- secutive patients. 2 Clinical material and methods Between September 1991 and July 1995, 26 patients underwent anterior cervical corpectomy. All of them had multi-levellesions. Fifteen patients had cervical spondylosis, one had OPLL and 11 had combined le- sions. There were 24 males and 2 females. The mean age at presentation was 52 years (range 37-78 years). Their neurological manifestations included gait di- sturbances, sensory and motor deficits, nuchal and shoulder pain and sphincteric dysfunction.Upper ex- tremity dysaesthesia, clumsy hands and gait distur- bance were the most common symptoms (Table I). Four patients had previously undergone multi-level laminectomy and had further deteriorated following surgery, while four patients had undergone anterior cervical discectomy with no neurological improve- ment. Harsh myelopathy grading was used to eva- luate the preoperative functional status of our pati- ents [7]. Nine of our 26 patients were bed ridden (grade IV), eight needed support of an assistant or walker (grade IIIc), eight patients had unsteady but independent gait (grade IIIa), and one had difficulty in running though he could walk (grade II) (Table II). ©1997 byWalter de Gruyter &Co. Berlin. New York