Fusion Free Median Corpectomy - Long-Term Consequence of Foregoing Fusion and Fixation: A Serendipitous Observation.

Background: Anterior cervical corpectomy and fusion (ACCF) involves placement of a graft/implant to ensure fusion and stabilization along with neural decompression. We share our experience with a subset of ACCF patients in whom graft/implant could not be placed post decompression for varying reasons but had a favorable long-term outcome. The necessity for routine fusion after corpectomy is critically analyzed, and the feasibility of an alternative surgical option without graft/implant is discussed.

Material and methods: A retrospective observational study of long-term outcomes of five patients with cervical compressive myelopathy who underwent neural decompression alone without an in situ graft/implant was done. All the patients underwent the modified cervical corpectomy technique, involving a smaller wedge size (12 × 15 mm) corpectomy. Pre- and postoperative clinical, radiological, electrophysiological, and operative findings were meticulously evaluated and analyzed.

Results: This retrospective observational study reviewed records of 124 patients who underwent ACCF between 1998 and 2012. The surgical procedure involved a wedge median cervical corpectomy. In seven patients, graft/implant could not be placed or had to be removed for various reasons. Long-term follow-up was available for five of these patients who were included in the study. In two patients, the graft could not be placed intraoperatively due to hemodynamic complications. In one patient, the graft had to be removed due to postoperative infection, and in two patients, the graft had to be removed due to graft extrusion. Four patients showed marked improvement, and one patient showed minimal improvement on long-term follow-up in clinical, radiological, and electrophysiological parameters.

Conclusion: This small case series suggests that a modified cervical corpectomy technique, involving a smaller wedge size (12 × 15 mm), may be considered in selected cases without radicular symptoms. This approach helps to provide neural decompression without compromising stability and avoids graft-related complications. While promising, further research, including prospective randomized-controlled trials, is essential to validate the biomechanical properties and clinical outcomes of this modified technique compared to traditional ACCF.