Cervical Corpectomy Surgery

Cervical corpectomy is a surgery that involves the removal of the vertebral body and the intervertebral disc to relieve pressure off the spinal cord and/or the spinal nerves. Corpectomy surgery is a more extensive surgery as compared to the traditionally performed anterior cervical discectomy and fusion.

The spinal cord runs from the base of the brain inside a canal formed by the consecutive vertebrae. At each level, spinal nerves branch from the spinal cord to supply various regions of the body. The intervertebral discs are soft tissues present between two adjoining vertebrae. The intervertebral discs function to cushion the various movements about the spine.

Indications

The corpectomy surgery is usually indicated secondary to severe compression of the spinal cord or/and spinal nerves. Degenerative disc disease involves the age-related wear and tear of the cervical spine.

The bone spurs may form secondary to the degenerative changes that may cause the compression of the neural structures. There may be stenosis or narrowing of the space available for the spinal nerves or the spinal cord, a condition known as cervical spinal stenosis.

The narrowing and compression of the spinal cord and/or nerves may lead to neck pain associated with numbness and tingling that may travel down to the shoulders, arm, and hands. In severe compression of the spinal cord, there may be a weakness of the upper extremities, including weakness of the hands. In some cases, there may be an associated weakness of the lower extremities and loss of bowel/bladder control.

Besides, the degenerative conditions and cervical spine stenosis, there may be compression of the spinal cord and/or nerves secondary to cervical vertebral fracture or tumor of the vertebral body. The corpectomy surgery is only indicated when all other methods of conservative treatment have been tried and failed. In cases where the pain is severe, or there is a neurological deficit in the form of weakness of the hands or bowel/bladder incontinence, surgery is indicated.

Procedure

After appropriate examination, the anesthesiologist numbs the patient in the form of general anesthesia. During general anesthesia, the patient sleeps while the surgery is performed.

The spine surgeon gives an incision in front of the neck, either on the right or the left of the midline. The surgeon carefully retracts the muscles, and the various nerves and blood vessels to reach the front of the involved cervical segment.

Intraoperative fluoroscopy is used to determine the correct level and somatosensory evoked potentials are used to monitor the nerves. The surgeon then removes the intervertebral discs above and below the level of the involved vertebra. A cutting tool is used to remove the attachments from the back of the vertebra.

The vertebral body is removed along with any other tissue which may be impinging upon the spinal cord/spinal nerves. The decompression is followed by the introduction of a bone graft. A solid strut bone graft is usually used which may be harvested from the patient’s own body during the same surgery.

The autologous strut bone graft is usually harvested from the front of the pelvic bone. In addition to the bone graft, a metallic or ceramic bone cage may be introduced to maintain the space occupied by the removed vertebra. A bone graft may also be taken from a bone bank or a man-made bone graft substitute may be used.

The spine surgeon may then introduce a metallic plate in front of the cervical spine to provide stability. The metallic plate is fastened to the adjoining vertebrae with the help of screws. Additional metallic hardware may be introduced from the back to provide more stability to the construct. The stability is checked again with the help of intraoperative fluoroscopy and the incision is closed in layers.

Recovery

The patient may have to stay overnight after the surgery is usually discharged the next day. A cervical collar may be used during the initial recovery period.

Pain medications may be prescribed and are usually weaned off after the initial postoperative pain subsides. The patients are advised to avoid bending the neck excessively and to avoid lifting weights and high impact activities.

Complications

As with any major surgery, there may be potential complications such as bleeding, infection or blood clots. Additionally, there may be subsidence of the bone graft or the cage. There may be incomplete fusion or no fusion at the corpectomy level. The hardware may break and there may be damage to the nearby blood vessels or nerves.

Rehabilitation and results

Physical therapy is usually started after the surgeon determines the fusion has healed. Physical therapy is aimed to increase the strength and flexibility of the muscles surrounding the neck. The majority of patients have excellent recovery post-op and return to the activities they enjoy without pain.