Settling of fibula strut grafts following multilevel anterior cervical corpectomy - A radiographic evaluation

Study Design. This is a retrospective study of settling of fibula strut grafts used for anterior cervical reconstruction. Objective. To measure settling and kyphotic angulation of uninstrumented fibula strut graft reconstruction for two- and three-level cervical corpectomy procedures. Summary of Background Data. Clinical experience indicates that some settling of anterior fibula strut grafts used in anterior cervical reconstruction will occur. The amount of settling and subsequent kyphosis using this technique has not been documented in the literature. Methods. Twenty-six patients having had nonvascularized autogenous fibula strut grafting without instrumentation following a two- or three-level corpectomy were studied. Baseline radiographic measurements of height and angulation on postoperative radiographs before hospital discharge were compared with measurements performed at least 2 years after surgery. Clinical follow-up was also available on all patients. Results. The average settling manifested by loss of height across the fused segments was 6.7 mm ( standard deviation, 5.71 mm). The average change in angulation was 2.5 degrees into kyphosis ( standard deviation, 6.09 degrees). Loss of height and angulation were not statistically different for two- versus three-level corpectomy patients. Pain outcomes did not correlate with the amount of settling or angulation. Conclusions. Some settling of autogenous fibula strut grafting without instrumentation can be expected. These findings did not correlate with residual postoperative axial neck pain.