Anterior cervical corpectomy spine surgery
Procedure for anterior cervical corpectomy spine
surgery
When the cervical disease encompasses more than just the disc space, the spine
surgeon may recommend removal of the vertebral body as well as the disc spaces
at either end, to completely decompress the cervical canal. This procedure, a
corpectomy, is often done for multi-level cervical stenosis with spinal cord
compression caused by bone spur (osteophytes) growth.
The general procedure for anterior cervical corpectomy
surgery is as follows:
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The approach is similar to a discectomy spine surgery
(anterior approach) although a larger and more vertical
incision in the neck will often be used to allow
more extensive exposure.
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The spine surgeon then performs a discectomy at
either end of the vertebral body that will be removed
(e.g. C4-C5 and C5-C6 to remove the C5 vertebral
body). More than one vertebral body may be removed.
-
The posterior longitudinal ligament is often removed
to allow access to the cervical canal and to ensure
complete removal of the pressure on the spinal cord
and/or nerve roots.
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The defect must then be reconstructed with an appropriate
fusion technique.
Potential risks and complications of anterior cervical
corpectomy surgery
Technically, a corpectomy is a more difficult spine surgery to perform. Similar
to a discectomy, the risks and possible complications include:
However, a corpectomy is a more extensive procedure
than a discectomy so the risks are statistically greater,
especially with respect to neurologic issues, bone
grafting and bleeding.
The risk that spine surgeons worry about the most
is compromise of the spinal cord that can lead to complete
or partial quadriplegia. Bear in mind that corpectomy
surgeries are most often undertaken in circumstances
of significant spinal cord problems, which place the
cord at greater risk for problems during surgery, independent
of the skill and finesse with which the procedure is
performed. To help manage this risk, the spinal cord
function is often monitored during surgery by Somatosensory
Evoked Potentials (SSEP’s). SSEP’s generate
a small electrical impulse in the arms/legs, measure
the corresponding response in the brain, and record
the length of time it takes the signal to get to the
brain. Any marked slowing in the length of time may
indicate compromise to the spinal cord.
There is also a slight risk that while removing the
vertebral body, the vertebral artery that runs on the
side of the spine may be injured, which can lead to
a cerebrovascular accident (stroke) and/or life-threatening
bleeding. This particular risk will be more significant
in certain instances of tumor removal or vertebral
infections.
Strut graft to achieve a spine fusion
After a corpectomy has been performed, the surgeon
needs to mechanically reconstruct the defect created
and to provide long-term stability of the spine with
a spine fusion. A strut graft is a piece
of bone (1-2 inches) that is inserted into the trough
created by the corpectomy(ies) that supports the anterior
vertebral column. The graft may be either an allograft
or an autograft, and is usually then followed by anterior
instrumentation to help hold the construct together.
Alternatively, ‘cages’ made
of titanium or other synthetic materials may be employed
as an alternative to strut grafts. Such cages are used
in combination with morsels of bone graft, which are
commonly the ‘local’ autograft bone obtained
from the patient as the vertebrae are removed. If multiple
levels are fused, a supplemental poster fusion and instrumentation
may be recommended to help stabilize the spine.
By: Peter
F. Ullrich, Jr., MD
October 7, 2005 (article
originally published September 8, 1999)
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