Clinical Cases
Cervical Corpectomy

Cervical corpectomy

Cervical corpectomy is an operation to remove a portion of adjacent vertebral bodies and intervertebral discs for decompression of the cervical spinal cord and spinal nerves. A bone graft with or without a metal plate and screws is used to provide stability. Cervical corpectomy may be performed from C-3 to C-7. Although it usually involves the excision of only a single vertebra along with its adjacent discs, a corpectomy can be extended to include as many as four vertebrae if necessary. Typically it is combined with a reconstructive procedure that involves the insertion of a strut graft or prosthetic device into the corpectomy defect. This construct may then be further secured by placing an internal fixation device.


Above is the scout film (plain PA radiograph taken to indicate which sections are taken on a CT scan) of the person on Table 3-5. Note the metal plate in the lower neck (also the chemo port on the right chest wall, threaded down into the right atrium). Scroll down to the fixation plate in the neck of the same person (between 40-45 on the time scale, located at approximately L9).

Indication for operation

The cervical spinal canal can be narrowed by bone spurs arising posteriorly from the vertebral body. When this occurs, it may be necessary to remove one or more of the vertebral bodies and intervertebral discs above and below to adequately decompress the spinal cord and nerve roots because the area of compression cannot be addressed by an anterior cervical discectomy alone.

The operation

The anatomical complexity of the cervical region contributes to the technical difficulty of the approach, as well as to the variety of surgery-related complications that can occur.

Since all surgery involves damage to the body, the plan is to get to the anterior surface of the vertebral bodies while doing the least damage to nerves, vessels, and visceral structures. As you can see on the image, a route medial to the sternocleidomastoid muscle and the carotid sheath, but lateral to the neck viscera will avoid major damage. Obviously, the strap muscles and especially their innervation from ansa cervicalis may take a severe beating.

Incision

The patient is positioned on their back. For the corpectomy, a small incision is made on either side of the neck, which may be extended for multiple corpectomies. If the patient's own bone will be used for the graft, an incision is made over the hip to harvest bone from the iliac crest.

Decompression

The cervical spine is exposed by separating the spaces between the normal tissues. The intervertebral discs above and below the vertebrae involved are removed. The middle portion of the vertebrae is removed (some of which is saved for use in the fusion) to decompress the underlying spinal cord and nerve roots.

Reconstruction

A strut of bone is placed to span the bony defect and provide support to the front of the spine. The bone fuses with the remaining vertebrae over time. Bone from the bone bank (allograft) may be substituted for the patient's own bone. A metal plate and screws are often used to provide extra support and facilitate the fusion process.

Closure

Absorbable sutures and or skin staples are used to close the incisions. A cervical collar may or may not be required for use after surgery. The doctor will follow the fusion with periodic x-ray exams after the operation.

What happens afterward?

Most patients experience only mild discomfort at the operative site, which is generally well controlled with oral pain medicines. A mild sore throat is not uncommon and is usually short lived. Most patients are discharged from the hospital in 24-48 hours. Patients may have immediate improvement in some or all of their symptoms, however, some symptoms may improve only gradually.

Complications

A wide variety of complications can occur as a result of cervical corpectomy procedures. Researchers have reported a series of 40 patients undergoing corpectomy in which the perioperative complication rate was 47.5%. Most of these complications were secondary to the soft-tissue exposure required for the corpectomy. Inadequate release of fascial tissue planes can result in damage to the esophagus, trachea, carotid or vertebral arteries, or the recurrent laryngeal nerve. Injury to the spinal cord or nerve roots is less frequent, but an incomplete decompression of the neural elements is more likely when an anterior cervical discectomy is performed. When a neural injury does occur during decompression, it most commonly involves the C-5 nerve root and is usually transient.