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 above and below to completely decompress the cervical canal.
This procedure is typically done in one operation with two parts:
- Anterior cervical corpectomy - to decompress the spinal cord and nerve roots.
- Spinal fusion - to provide strength and stability.
In This Article:
- Anterior Cervical Corpectomy Spine Surgery
- Anterior Cervical Corpectomy: The Procedure
Anterior Cervical Corpectomy step by step:
The general procedure for anterior cervical corpectomy surgery is as follows:
- An incision is made in the front of the neck. It may be a longer incision if multiple spinal levels are involved.
- The muscles and other tissues in the front of the cervical spine are gently moved to the side to allow the surgeon to visualize the front of the bones and discs in the cervical spine.
- The surgeon then removes the disc (a discectomy) at each end of the vertebral body that will be removed (e.g. C4-C5 and C5-C6 discs are removed to remove the C5 vertebral body). More than one vertebral body may be removed, if necessary.
- The posterior longitudinal ligament is commonly removed to ensure complete decompression of the spinal cord.
- The spinal cord and nerve roots are decompressed. For example, any bone spurs (osteophytes), or other pathology (tumor, infection, fracture fragments) pressing on the spinal cord or nerve roots are surgically removed.
A spinal fusion is then performed at the cervical spinal levels involved in the above steps.
The Spinal Fusion Part of the Surgery
After a corpectomy has been performed, the surgeon needs to mechanically reconstruct the defect created and to provide the long-term strength and stability of the spine with a spinal fusion.
The fusion portion of the surgery is done during the same corpectomy operation.
It is typically done in one of two ways:
A strut graft. This approach involves using a piece of bone 1-2 inches long, called a strut graft, that is inserted into the trough created by the corpectomy(ies) and that supports the front of the 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.
Spinal cage. Alternatively, a cage may be inserted into the space to set up the fusion.
A cage is a medical device made of titanium or other synthetic materials. The cage is inserted into the space where the vertebrae and discs were and fixed into place with screws and plates.
Morsels of bone graft are inserted into the cage to help achieve the bone fusion. These morsels are commonly the ‘local’ autograft bone, which means that they are taken from vertebrae that have been removed from the patient during the corpectomy and then inserted into the cage device.
If multiple levels are fused, a supplemental posterior fusion (from the back of the neck) and instrumentation may be recommended to help stabilize the spine.
When the surgery is complete the incision is closed and covered by a type of surgical dressing, or steri-strips may be used.
Often a temporary drain is placed to prevent blood or tissue fluid from accumulating in the wound.
Anterior Cervical Corpectomy Potential Risks
The possible risks and complications of this surgery for cervical spinal stenosis include, but are not limited to:
- Incomplete symptom relief
- Incomplete neurologic recovery
- Nerve root damage
- Damage to the spinal cord
- Bleeding Infection
- Graft dislodgment
- Damage to the trachea/esophagus
- Continued pain
- Failure to fuse (failed back surgery syndrome, also called pseudoarthrosis)
The potential risks and complications tend to increase when more than one level of the cervical spine is involved, if the patient has certain additional medical conditions, or other individual risk factors.
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, two approaches are commonly used:
- The spinal cord function is often monitored during surgery by Somatosensory Evoked Potentials (SSEP).
- Coordinated efforts with anesthesia to maintain adequate blood pressure (spinal cord blood flow) is also inherent to the operation.
SSEPs 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 of 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 spinal tumor removal or vertebral infections.
Follow-up Care
Most patients stay in the hospital at least overnight and are discharged to go home the next day.
A sequence of follow-up visits will be scheduled to check on the healing, at which time an x-ray will be done to gauge if the spinal fusion is healing as expected, which takes at least 3-6 months.
Postoperative instructions will be reviewed prior to discharge, for example:
- How to take care of the incision site
- How to manage postoperative pain and stiffness in the neck and shoulders
- Guidance for rest and activity restrictions, brace wear, etc.
- Physical therapy
Many surgeons will prescribe a cervical collar, which is a type of neck brace, to support the muscles in the neck for the first several weeks following the surgery.
A typical initial recovery period is six to eight weeks, followed by a period of several months while the fusion continues to set up.
