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Surgeon's Guide to Corpectomy

Vertebral discs can protrude or push into the spinal canal. This puts pressure on the spinal cord causing painful symptoms. In the cervical spine (neck), this condition is called cervical myelopathy. To treat this problem, the discs can be removed in an operation called discectomy.

If bone spurs around the disc and a bulging disc take up too much space, the spinal canal narrows in a process called stenosis. When combined together, myelopathy and stenosis may require discectomy and corpectomy. Corpectomy is removal of the vertebral bone. The goal of both procedures is to decompress (take pressure off) the neural tissues.

In this review article, surgeons from the University of Wisconsin discuss surgical corpectomy for cervical spondylotic myelopathy. Who should be considered for this operation? How should the operation be done? What kind of problems can occur during and after the operation? And finally, the prognosis for outcome is discussed.

Anyone with severe pain that doesn't go away with conservative care is a candidate for cervical corpectomy. The best results occur when only one or two levels are affected. Patients who aren't already disabled from this condition or who have had symptoms for less than a year have the best results.

The surgeon must carefully remove the disc, bone spurs, and thickened ligaments. The spine must be stabilized to prevent excess motion called hypermobility. Balance of position and movement of the spine are maintained as much as possible.

The authors discuss surgical approach, position of the patient, and incision. Specific details of the operation are included with drawings to show other surgeons where and how to drill, remove bone, and place bone graft.

Avoiding complications can be done by carefully selecting patients and planning overall patient care. Sore throat and difficulty swallowing will go away gradually. Injury to the laryngeal nerve can be more serious. The results can be loss of voice, hoarseness, and chronic cough. Injury to blood vessels must also be avoided. Specific operative techniques are offered for these and other complications.

References: Joshua E. Medow, MD, et al. Surgical Management of Cervical Myelopathy: Indications and Techniques for Surgical Corpectomy. In The Spine Journal. November/December 2006. Vol. 6. No. 6S. Pp. 223S-241S.

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