Abstract
Introduction
Anterior reconstruction has the advantage of conferring immediate stability to the cervico-thoracic junction
Aims and objectives
Assess clinical and radiological outcome in cervico-thoracic kyphosis treated with anterior reconstruction.
Material and methods
62 cases were treated with anterior reconstruction from 1996-2007. Minimum follow-up was 2years (2-6). Indications included tuberculosis (45), dysplastic(10), neoplastic (3) and traumatic (4). Average age was 28.6 years (13-72 years). Average pre-operative kyphosis was 26.4 degrees (5-84). Patients were grouped as long-neck (35) and short-neck (27) according to classification proposed by Bapat and Laheri. The caudal normal vertebra (CNV) matched on plain radiology and MRI in 40 (64.51%). In 22 level of fixation was extended due to poor bone mass in the adjacent vertebral body (caudal 17, cranial 5). Pre-operative neurological deficit was seen in 57 (91.3%) and average Nurick's grade was 3.8 (0-5).
Results
32 long-neck patients required strap-muscle tenotomy to expose the CNV. In 3(9.3%) manubriotomy was required (large neck girth 1, thyroid goitre 2). 26 short-neck patients required manubriotomy for plate placement. In 42 (67.8%) patients a standard anterior cervical plate was used. In 22 locking plate was used. Commonest cranial and caudal vertebrae instrumented were C7 (32) and T2 (20) respectively. Post-operative kyphosis averaged 14.68 degrees (0-78) and correction averaged 11.72 degrees. Average post-operative Nurick's grade was 2.8. One patient with fracture dislocation of T1-T2 and traumatic oesophageal rupture died. In 1 the implant loosened and was revised with posterior construct. In 1, screw loosening was observed but implant position remained unaltered. 2 patients had recurrent laryngeal palsy. Iatrogenic pleural rent occurred in 2 patients. Transient dysphagia was noticed in 12. The scar hypertrophy was seen in 30(48.38%). The loss of correction averaged 2.3mm (0-4mm) at the final follow-up.
Conclusion
Anterior reconstruction allows excellent reconstruction of cervico-thoracic junction obviating need for a posterior construct.
