P116. Upper cervical corpectomy: Outcomes and complications

BACKGROUND CONTEXT Given the rare indications, upper cervical corpectomy of the C3 and/or C4 region is an uncommon procedure. The complex anatomy of the upper cervical spine can make exposure and corpectomy of this region technically challenging. There are several case reports of upper cervical corpectomy within the literature. However, there are few case series including the results of upper cervical corpectomy, and to the authors’ knowledge, none exclusively report the outcomes and complications of corpectomy at the C3 and/or C4 level. In addition, a previous study within the literature demonstrated that patients with corpectomy involving the C4 vertebral body (alone or as part of multilevel corpectomy) were significantly more likely to suffer complications. PURPOSE The purpose of this study is to describe our tertiary referral center's outcomes and complications following upper cervical corpectomy. The authors hypothesized that upper cervical corpectomy is associated with a greater propensity for complications considering the complex anatomy of this region. STUDY DESIGN/SETTING Retrospective case series. PATIENT SAMPLE All patients undergoing anterior cervical spine procedures by the senior author from 11/2012 to 10/2020 at a level I trauma center and regional cancer center were identified. OUTCOME MEASURES Length of hospital stay, estimated blood loss (EBL), discharge disposition, intraoperative complications, perioperative complications, and Neck Disability Index (NDI) scores. METHODS Patients undergoing C3 and/or C4 corpectomies with a follow-up of greater than 6 months were enrolled. Demographic information, diagnoses, ASIA grade, surgical data, complications, and NDI scores were collected. RESULTS A total of 247 patients undergoing anterior cervical procedures were identified. Ten of 247 (4%) underwent upper cervical corpectomies. Four out of 10 (40%) had a C3 corpectomy, 1 out of 10 (10%) had C3 and C4 corpectomies, 3 out of 10 (30%) had a C4 corpectomy and 2 out of 10 (20%) had C4 and C5 corpectomies. Mesh cages were used in 9/10 cases and fibula strut allograft used in one case. The average age was 55.5 years. (16-76 years), and there were 6 males and 4 females. Diagnoses were: 3 tumors, 3 fractures, 2 cervical spondylotic myelopathy (CSM), 1 central cord syndrome and 1 epidural abscess. Six of 10 procedures were performed emergently due to neurological deficits or instability. ASIA grade was: E (7), D (2), and B (1). An average of 3 levels were fused with an average EBL of 225 ml (25ml – 800ml). Average hospital stay was 12.25 days, and 4 of 10 patients were discharged to rehabilitation. There were no intraoperative complications. There were 4 patients with postoperative complications, including fibula strut graft dislodgement (n=1, 10%), temporary facial nerve neuropraxia (n=1, 10%), seroma (n=1, 10%), hematoma (n=1, 10%), PEG tube placement (n=1, 10%), and systemic complications (n=4, 40%, ie, pulmonary embolism, pneumonia, C. difficile colitis, respiratory failure). Of the 10 patients included, 9 had NDI surveys completed at their latest follow-up at least 6 months postoperatively. The average latest follow-up visit was 21.1 months, and the mean NDI score at the latest clinic visit was 15.7. CONCLUSIONS In this case series, cervical corpectomy at the level of C3 and/or C4 was performed in patients with tumors, fractures and myelopathy, and demonstrated a surgical complication rate of 40%. Upper cervical corpectomy is uncommon, sparsely reported, and demonstrated high rates of complications; these findings may help guide clinician management and patient expectations of upper cervical corpectomy. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.