Spine - 2026-07-20 - Journal Article
Complication Profiles of Corpectomy-Containing Versus Non-Corpectomy Anterior Cervical Surgery for Degenerative Cervical Myelopathy: A Multicenter Study of 1,024 Cases.
Hirai T, Sakai K, Onuma H, Hashimoto M, Horiuchi A, Inose H, Yamada K, Matsukura Y, Morishita S, Egawa S, Kawabata A, Takahashi T, Hashimoto J, Tamura S, Torigoe I, Tomori M, Sakaki K, Otani K, Kusano K, Yamada T, Ushio S, Shindo S, Arai Y, Yoshii T
Topics
Key Takeaway
Corpectomy-containing anterior cervical procedures carried a 38.1% perioperative local complication rate versus 16.5% for non-corpectomy procedures (OR 1.82, 95% CI 1.22–2.72), though this association attenuated after adjusting for surgical extent and OPLL.
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Summary
This multicenter retrospective study compared perioperative and late complication profiles between corpectomy-containing (ACCF/hybrid) and non-corpectomy (ACDF/TDR) anterior cervical procedures in 1,024 myelopathy patients across three Japanese centers. Corpectomy procedures had markedly longer operative time (308 vs. 150 min), greater blood loss (307 vs. 47 mL), higher dural injury rates (17.4% vs. 1.5%), upper-extremity weakness (13.0% vs. 4.2%), and reoperation rates (9.8% vs. 2.4%). After multivariable adjustment for demographics and OPLL, the complication excess was substantially explained by surgical extent rather than corpectomy per se.
Key Limitation
The attenuation of the corpectomy-complication association after adjusting for surgical extent suggests residual confounding by indication—sicker patients with more severe or multilevel OPLL were selectively funneled to corpectomy, making it impossible to isolate procedure-specific risk from disease severity.
Original Abstract
STUDY DESIGN
Retrospective multicenter cohort study.
OBJECTIVE
To compare perioperative and late complication profiles between non-corpectomy and corpectomy-containing anterior cervical procedures for cervical myelopathy.
SUMMARY OF BACKGROUND DATA
Although anterior cervical surgery is effective for direct decompression of anterior cord compression, surgical invasiveness differs substantially according to whether corpectomy is required. Comprehensive perioperative and late complication profiles comparing non-corpectomy and corpectomy-containing procedures in large myelopathy cohorts remain insufficiently characterized.
METHODS
We reviewed 1,024 patients who underwent anterior cervical surgery for cervical myelopathy at three Japanese spine centers between 2011 and 2021. Patients were grouped into non-corpectomy procedures, including ACDF, TDR, or other disc-space-based procedures (n=617), and corpectomy-containing procedures, including ACCF or hybrid ACDF/ACCF procedures (n=407). Perioperative local complications, airway/swallowing-related complications, upper-extremity weakness, perioperative reoperation, late complications, and late reoperation were compared. Multivariable logistic regression evaluated associations between procedure group and complications.
RESULTS
Compared with non-corpectomy procedures, corpectomy-containing procedures were associated with longer operative time, 308 versus 150 minutes, and greater blood loss, 307 versus 47 mL. Perioperative local complications occurred in 257 patients, 25.1%, and were more frequent after corpectomy-containing procedures than after non-corpectomy procedures, 38.1% versus 16.5%, P<0.001. Corpectomy-containing procedures also showed higher unadjusted rates of reoperation, 9.8% versus 2.4%; upper-extremity weakness, 13.0% versus 4.2%; dural injury, 17.4% versus 1.5%; upper airway obstruction, 8.8% versus 4.9%; and airway/swallowing-related complications, 20.9% versus 15.1%. After adjustment for age, sex, BMI, smoking, diabetes, and OPLL, corpectomy-containing procedures remained associated with perioperative local complications, odds ratio 1.82; 95% confidence interval, 1.22-2.72. However, this association was attenuated after additional adjustment for surgical extent.
CONCLUSIONS
Corpectomy-containing procedures showed greater unadjusted perioperative morbidity than non-corpectomy procedures in patients undergoing anterior cervical surgery for myelopathy. Much of this increased complication burden appeared to reflect OPLL pathology and greater surgical extent. These findings may inform procedure selection, perioperative risk stratification, and patient counseling.