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  • Two level corpectomy versus three level discectomy of the cervical spine, which is preferred?: analysis of spinal alignment, adjacent level disease, neck pain, and neurologic outcomes

    Final Number:

    Darryl Lau; Dean Chou M.D.; Praveen V. Mummaneni MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: It remains to be determined whether multilevel corpectomy or multilevel discectomy is able to offer the best outcomes. In this study, we compared 2-level corpectomy against 3-level ACDF by assessing spinal alignment, adjacent level disease, pain, and neurologic function.

    Methods: Between 2006 and 2011, all patients who had 2-level corpectomy or 3-level ACDF were identified. Outcomes of blood loss, complications, spinal alignment, adjacent segment disease, (VAS) neck pain, and Nurick scores were examined. Fischer's exact test and student’s two tailed t-test were used to compare the two groups.

    Results: 29 patients underwent 2-level corpectomy and 35 patients had 3-level ACDF. In the corpectomy group, mean age was 56.5 years and 66.6% were male. In the discectomy group mean age was 59.3 years and all patients were male. There were no significant differences in preoperative comorbidities, pain, Nurick score, and spinal alignment between the two groups. Mean follow-up was 20.0 months and 21.7 months for the 2 level corpectomy group and the 3 level ACDF groups, respectively. 2 level corpectomy was associated with significantly higher blood loss compared to 3 level ACDF (326.2 cc vs. 130.0 cc, p=0.004). Overall complication rate for 2 level corpectomy was 10.3% and overall complication rate for 3 level ACDF was 8.6%; this difference was not statistically significant (p=0.999). Also, there were no significant differences in follow-up VAS neck pain score (1.2 vs.1.1, p=0.945), Nurick score (1.1 vs. 0.6, p=0.444), correction of spinal alignment (11.1 degrees vs. 8.3 degrees, p=0.475), and rate of adjacent level disease (6.9% vs. 5.7%, p=0.869).

    Conclusions: These findings suggest 2-level corpectomy and 3-level ACDF offer similar outcomes in regards to spinal alignment, adjacent segment disease, neck pain, and neurologic function. However, the group that underwent corpectomy had greater blood loss.

    Patient Care: This will provide clinicians additional information when trying to decide whether corpectomy or discectomy should be performed.

    Learning Objectives: 1. Discuss the in which situations are better for corpectomy or discectomy 2. Recognize that long-term outcomes are similar in patients who under go 2-level corpectomy and 3 level discectomy.


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