Clinical Evaluation of Failures in Primary Anterioi Cervical Cord Decompression and Fusion

Recently, postoperative results of cervical spondylosis, disc herniation, tumor, and ossiication of posterior longitudinal ligament(OPLL) after anterior cervical surgeries have been improving due to new kinds of medical imaging, electrophysiological examinations, improved operative equipment, and improved surgical technique. However, occasional unsatisfactory cases needing a secondary operation remain. The author analyzed and developed strategies for multioperated cervical cases : all patients had two or more operations. From Sep. 93 to Aug. 98, 167 anterior cervical surgeries with fusions were performed in Dept. of Neurosurgery, Tong Dae Moon hospital. The author experienced 11 cases(6.6%) of failed anterior cervical surgeries and fusions : 8 men and 3 women. Initial diagnosis was 1 spondylosis, 2 cervical traumas, 3 disc herniations, and 5 cases of ossification of posterior longitudinal ligament. These multioperated cases were classified by the following cases : hardware-related complications, graft-related complications, and others. These groups were analyzed, and the resulting surgical strategies, including indications and techniques of anterior surgery, are described. The results of this study indicates that in order to reduce the need for multioperated cases, initial skillful surgical techniques and proper understanding of cervical spinal anatomy are necessary.