In our last few posts we discussed anterior cervical discectomy and fusion (ACDF) as a treatment for cervical disc disease and spondylosis. In ACDF a degenerated disc (or discs) is removed to decompress the spinal cord or a cervical nerve root. In some cases, though, removing the disc alone is not sufficient to adequately decompress the spinal cord. In these cases a corpectomy is performed in which the entire vertebral body as well as the adjacent discs are removed. A corpectomy can be performed at just about any level of the spine. In this post, though, we’ll discuss the use of corpectomy for pathology of the cervical spine.
Again, in some cases of degenerative disc disease and spondylosis, ACDF alone is insufficient to adequately decompress the spinal cord. For example, some patients with cervical spondylosis and stenosis will have osteophytes (fancy word for bone spurs) that form not only at the disc space (where they could be removed with a standard ACDF) but also behind the entire vertebral body (see figure 1). Thus, a corpectomy is necessary to remove the osteophytes behind the vertebral body and decompress the spinal cord.
Figure 1. Sagittal T2 MRI of cervical spine demonstrating spinal cord compression from displaced cervical discs (red stars) as well as from large osteophyte behind vertebral body (red arrow.)
Cervical corpectomy is also used in cases of trauma, tumor or infection in which the vertebral body has been destroyed. This bony destruction may render the spine unstable. In these cases the vertebral body is completely removed (along with the offending pathology) so that the spine can then be reconstructed and stabilized (see figure 2).
Figure 2. Left image is CT scan of cervical spine demonstrating C5 burst fracture (red arrow) in an adolescent male who dove into shallow water. Right image is sagittal T2 MRI in same patient demonstrating fractured vertebral body (red arrow) and edema in spinal cord indicative of spinal cord injury (blue arrow.)
The first steps of a cervical corpectomy procedure are identical to the steps of an ACDF (to review, click here). Once at the spine the intervertebral discs above and below the vertebral body in question are removed. After the discs are removed the vertebral body is removed with a high-speed drill; the bone dust is collected with a special suction trap to be used later as graft material. Once the vertebral body has been removed and the spinal cord has been decompressed (after removal of the posterior longitudinal ligament) a spacer is sized to fit the defect left by the corpectomy. As with ACDF these spacers come in a variety of shapes, sizes and materials. I typically use a PEEK spacer (see figure 3) that is packed with the bone harvested from the corpectomy (or cadaver bone in cases of tumor or infection when the patient’s bone can’t be reused.) The risk profile is also similar that that of ACDF although the risks of dysphagia, vertebral artery injury and non-union (when the bones don’t fuse) are slightly higher for cervical corpectomy than for ACDF. Length of hospital stay and recovery is typically the same as for ACDF.
Figure 3. Polyetheretherketone (PEEK) spacer. (source: http://www.globusmedical.com)
In my practice I typically reserve cervical corpectomy for unique circumstances (i.e. tumor or trauma.) In properly selected patients the outcomes are excellent. See all of the steps of a cervical corpectomy that I performed recently in the video below.
J. Alex Thomas, M.D.