Careful follow-up after "successful" surgery: postoperative spondylolisthesis after anterior cervical corpectomy and fusion with instrumentation

Abstract

Background: Anterior cervical corpectomy and fusion with instrumentation is a common procedure for the surgical treatment of cervical spinal cord and/or nerve root decompression or for deformity correction. However, various postoperative complications have been associated with such a surgical intervention. Postoperative spondylolisthesis after an anterior cervical corpectomy with instrumentation is a serious complication that has rarely been addressed in the literature, and may potentially be underreported. Case Description: A 44-year-old woman with degenerative disk disease, loss of cervical lordosis, congenital cervical stenosis at C5-C6, and a left-sided herniated disk at C6-C7 underwent an anterior cervical corpectomy of C6 with fusion and anterior plate stabilization of C5-C7. Early postoperative evaluation noted complete resolution of the patient's symptoms. At 6 months after surgery, the patient complained of neck pain and intermittent headaches. Radiographic evaluation noted fusion of the corpectomy strut graft with retrolisthesis of C5 on C6 and early myelomalacia at C5-C6. A cervical laminectomy with posterior instrumentation from C5 to C7 was performed and the patient's symptoms resolved. Conclusions: Postoperatively, a high index of suspicion should be present for the development of spondylolisthesis in patients undergoing an anterior cervical corpectomy and fusion procedure with or without instrumentation, particularly in individuals with persistent or new symptoms even after a "successful" operative procedure. The spine surgeon should address appropriate operative techniques and postoperative management to decrease the risk of spondylolisthesis after such a procedure. © 2008 Elsevier Inc. All rights reserved.