Ectopic Gas in the Fibular Graft After Anterior Cervical Corpectomy and Fusion

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2021 Nov 30

PMID 34844589

Authors

Satoshi Nozawa

Hiroki Kato

Masaya Kawaguchi

Asae Nozawa

Kazunari Yamada

Chizuo Iwai

Kazunari Fushimi

Kei Miyamoto

Hideo Hosoe

Katsuji Shimizu

Masayuki Matsuo

Haruhiko Akiyama

Affiliations

Soon will be listed here.

Abstract

Background: Ectopic gas in the graft is occasionally encountered upon follow-up computed tomography (CT) after anterior cervical corpectomy and fusion (ACCF). However, most cases lack inflammatory responses and manifestations of infection. Although the clinical significance of ectopic gas in the graft has not yet been established, to the best of our knowledge, no previous studies have described ectopic gas in the graft after ACCF. This study evaluated ectopic gas in the fibular graft upon follow-up CT after ACCF.

Methods: We reviewed 112 patients who underwent ACCF and follow-up CT, with a minimum follow-up period of 3 years. CT images were retrospectively reviewed to confirm the presence of ectopic gas in the graft and bone fusion. Bone fusion was defined as follows: mobility less than 2 mm between spinous processes on the flection-extension radiograph or a bone bridge on CT images.

Results: Of the 112 patients, 30 (27%) patients had ectopic gas in the fibular grafts. Among them, ectopic gas was initially observed 3 months after surgery (early onset) in 23 (77%) patients and 6 months after surgery (late-onset) in the remaining seven (23%) patients. Upon the latest follow-up CT, ectopic gas more frequently remained in late-onset (4/7, 57%) rather than in early-onset (3/23, 13%) cases (p = 0.033). Bone fusion was not observed when CT images exhibited ectopic gas in the graft, whereas ectopic gas was not observed when CT images exhibited bone fusion.

Conclusion: Ectopic gas in the fibular graft was observed at both early and late-onset after ACCF; late-onset gas remained significantly. The remaining gas was strongly associated with pseudoarthrosis; therefore, pseudoarthrosis should be considered when ectopic gas in the graft is observed on CT images.

References

Emery S, Bohlman H, Bolesta M, Jones P . Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up. J Bone Joint Surg Am. 1998; 80(7):941-51. DOI: 10.2106/00004623-199807000-00002. View

Hoover J, Wenger D, Eckel L, Krauss W . Cervical pneumatocyst. J Neurosurg Spine. 2011; 15(3):332-5. DOI: 10.3171/2011.5.SPINE10627. View

Maldague B, Noel H, Malghem J . The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology. 1978; 129(1):23-9. DOI: 10.1148/129.1.23. View

Yamamoto T, Yoshiya S, Kurosaka M, Nagira K, Takabatake M, Hamamoto H . Natural course of an intraosseous pneumatocyst of the cervical spine. AJR Am J Roentgenol. 2002; 179(3):667-9. DOI: 10.2214/ajr.179.3.1790667. View

Ikenaga M, Shikata J, Tanaka C . Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy. Spine (Phila Pa 1976). 2006; 31(14):1568-74. DOI: 10.1097/01.brs.0000221985.37468.0f. View

Sandstrom C, Osman S, Linnau K . Scary gas: intravascular, intracranial, and intraspinal ectopic gas (part III). Emerg Radiol. 2017; 24(4):411-416. DOI: 10.1007/s10140-017-1492-8. View

Jiang S, Jiang L, Dai L . Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical spondylosis: a systematic review. Arch Orthop Trauma Surg. 2011; 132(2):155-61. DOI: 10.1007/s00402-011-1402-6. View

Ikenaga M, Shikata J, Tanaka C . Anterior corpectomy and fusion with fibular strut grafts for multilevel cervical myelopathy. J Neurosurg Spine. 2005; 3(2):79-85. DOI: 10.3171/spi.2005.3.2.0079. View

Bohlman H, Emery S, Goodfellow D, Jones P . Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am. 1993; 75(9):1298-307. DOI: 10.2106/00004623-199309000-00005. View

10.

Steinhaus M, York P, Bronheim R, Yang J, Lovecchio F, Kim H . Outcomes of Revision Surgery for Pseudarthrosis After Anterior Cervical Fusion: Case Series and Systematic Review. Global Spine J. 2020; 10(5):559-570. PMC: 7359693. DOI: 10.1177/2192568219863808. View

11.

Hilibrand A, Fye M, Emery S, Palumbo M, Bohlman H . Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression. Spine (Phila Pa 1976). 2002; 27(2):146-51. DOI: 10.1097/00007632-200201150-00005. View

12.

Uribe J, Sangala J, Duckworth E, Vale F . Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up. Eur Spine J. 2009; 18(5):654-62. PMC: 3234010. DOI: 10.1007/s00586-009-0897-9. View

13.

Komura S, Miyamoto K, Hosoe H, Fushimi K, Iwai C, Nishimoto H . Anterior cervical multilevel decompression and fusion using fibular strut as revision surgery for failed cervical laminoplasty. Arch Orthop Trauma Surg. 2010; 131(9):1177-85. DOI: 10.1007/s00402-010-1248-3. View

14.

Karasick D, Eason M . Vertebral pneumatocyst mimicking susceptibility artifact on MR imaging. AJR Am J Roentgenol. 1998; 170(1):221. DOI: 10.2214/ajr.170.1.9423641. View

15.

Nozawa S, Miyamoto K, Sakaguchi Y, Hosoe H, Shimizu K . Ossification of the posterior longitudinal ligament associated with rheumatoid arthritis. Orthopedics. 2004; 27(6):623-4. DOI: 10.3928/0147-7447-20040601-22. View

16.

Resnick D, Niwayama G, Guerra Jr J, Vint V, Usselman J . Spinal vacuum phenomena: anatomical study and review. Radiology. 1981; 139(2):341-8. DOI: 10.1148/radiology.139.2.7220878. View

17.

Coulier B . The spectrum of vacuum phenomenon and gas in spine. JBR-BTR. 2004; 87(1):9-16. View

18.

Cannada L, Scherping S, Yoo J, Jones P, Emery S . Pseudoarthrosis of the cervical spine: a comparison of radiographic diagnostic measures. Spine (Phila Pa 1976). 2003; 28(1):46-51. DOI: 10.1097/00007632-200301010-00012. View

19.

Neo M, Fujibayashi S, Yoshida M, Nakamura T . Spinous process plate fixation as a salvage operation for failed anterior cervical fusion. Technical note. J Neurosurg Spine. 2006; 4(1):78-81. DOI: 10.3171/spi.2006.4.1.78. View

20.

Nirala A, Husain M, Vatsal D . A retrospective study of multiple interbody grafting and long segment strut grafting following multilevel anterior cervical decompression. Br J Neurosurg. 2004; 18(3):227-32. DOI: 10.1080/02688690410001732643. View