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| Home > Surgical Treatments > Decompression > Cervical Corpectomy - Overview |
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ANTERIOR CERVICAL CORPECTOMY
Overview
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When the cervical disease encompasses more than just the disc space, the 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 performed for multi-level cervical stenosis.
For patients whose pain does not improve with non surgical treatments, surgery may be necessary. The treatment's goal is to relieve pressure on the nerve roots or on the spinal cord by removing the ruptured disc and vertebral body . After a skin incision is made, only one thin muscle needs to be cut, after which anatomic planes can be followed right down to the spine. This procedure is usually done under microscopic visualization. The limited amount of muscle transection or dissection helps to limit postoperative pain.
General Procedure
- Surgical approach
- The skin incision is about one inch and horizontal and can be made on the left or right hand side of the neck. A more vertical incision in the neck will often be used to allow more extensive exposure.
- The thin platysma muscle is then split and the plane between the sternocleidomastoid muscle and the strap muscles is then entered.
- Next, a plane between the trachea/esophagus and the carotid sheath can be entered.
- A thin layer of fibrous tissue that covers the spine can easily be dissected away from the disc space.
- Disc and vertebral body removal
- A needle is then inserted into the disc space and an x-ray is done to confirm that the surgeon is at the correct level of the spine.
- After the correct disc space has been identified on x-ray, the disc is then removed by first cutting the outer annulus fibrosis (fibrous ring around the disc) and removing the nucleus pulposus (the soft inner core of the disc).
- The 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 then removed to allow access to the cervical canal. This procedure allows the canal to be completely decompressed. The dissection is often performed using an operating microscope to aid with visualization of the canal.
- Dissection is carried out from the front to back to a ligament called the posterior longitudinal ligament. This ligament can be gently removed to allow access to the spinal canal to remove any osteophytes (bone spurs) or disc material that may have extruded through the ligament.
 - Strut grafting
- Corpectomy results in a very unstable situation and must be addressed.
- Often a strut graft is used to bridge the gap (shown in red). This is often not enough stability, and a plate is also used anteriorly (green).
- Even with the plate, the stability may not be enough, and this may necessitate posterior instrumentation also.
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