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Cervical Corpectomy Surgery

What does “Cervical Corpectomy” mean”?

  1. Cervical: means in the spine in the neck
  2. Corpectomy: means removal of a portion of the body of a vertebra

Altogether, “Cervical Corpectomy” means removing a portion of a vertebra in the neck.

What is a Cervical Corpectomy?

A cervical corpectomy is a surgery where the front portion of the body of a vertebra is removed in order to take pressure of the spinal cord. In addition, the discs on the top and bottom of the vertebra are removed as well. As an example, if a portion of the C5 vertebra is compressing the spinal cord, the C4/5 and C5/6 discs, as well as a portion of the C5 vertebra are removed. Finally, an implant made of bone, bone substitute, or metal with bone in the center is then placed in the defect. This implant is then supported with a titanium plate to secure it.

Why is a Cervical Corpectomy done?

A cervical corpectomy is typically done when the compression of the spinal cord is not just due to a disc problem, but a bone spur from the vertebra itself is compressing the spinal cord. Removing the discs would not be enough to relieve the compression of the spinal cord.

A cervical corpectomy is a more aggressive surgery than a discectomy, since both discs and bone from the vertebra have to be removed.

The goals of a cervical corpectomy are as follows:

  1. Remove any compression of the spinal nerves or spinal cord from the diseased discs.
  2. Remove any compression of the spinal cord from the body of the vertebra (spurs)
  3. Place a bone-filled titanium cage, or a long piece of bone into the area where the discs and vertebra were removed to allow the entire area to fuse together and become one large piece of vertebra.

How is a Cervical Corpectomy actually done?

The following description is for a one or two spinal level cervical corpectomy. If more vertebrae have to be removed, this surgery is typically combined with a “posterior cervical fusion”.

  1. An intravenous catheter (IV) is place in the patient and antibiotics are given.
  2. This surgery takes place in an Operating Room.
  3. The patient is placed on their back (supine) on the operating room table.
  4. The Anesthesia provider puts the patient to sleep under General Anesthesia.
  5. The patient’s head and neck are often secured to prevent any movement during surgery.
  6. The front and sides of the neck are cleaned with a surgical antiseptic and plastic covers (drapes) are placed around the area where the cut (incision) will be made.
  7. Often, a small metal device is placed on the neck and an X-Ray is taken. This helps the surgeon to find out where exactly the cut (incision) should be made. The X-Ray will show the metal device and over which disc or vertebra it is located.
  8. A cut (incision) is made through the skin with a surgical knife.
  9. The first structure under the skin is the platysma muscle. This muscle is carefully split so that the deeper structures in the neck can be seen.
  10. Next, the neck fascia can be seen. Fascia is a layer of thin but tough material which separates different structures. This fascia surrounds muscles, blood vessels, organs, etc.
  11. The fascia is also split to see the structures below it.
  12. The group of deeper muscles (strap muscles) of the neck are pushed off to one side. A surgical retractor is used for this. Retractors are like “rakes” which are used to gently push structures out of the way so the surgeon can locate and see what is underneath.
  13. The swallowing tube (esophagus) is located and pushed off to the other side.
  14. The front of the neck (cervical spine) can now be seen.
  15. A disc is identified and a small needle is put into the disc above and below the targeted vertebra.
  16. An X-Ray is taken from the side. The discs with the needle in them can be seen. The discs are now numbered to make sure that the correct discs have the needle in them.
  17. The discs are now removed with a knife and several other surgical tools. This is the most delicate part of the surgery. The surgeon has to be careful to remove all the parts of the disc which can cause a problem.
  18. Next, the body of the vertebra is targeted. Using small burrs (like a dentist’s drill) are used to remove the center part of the vertebral body. Small, delicate instruments are used to remove the last layer of bone on top of the spinal cord.
  19. The top and bottom sides of the vertebrae (endplates) above and below the area where discs were removed are now prepared for the implant.
  20. The space where disc and bone material was removed from is measured to make sure the correct size of implant is chosen. The implant itself could be bone from the patient (usually fibula from lower leg), a bone-like material (bone substitute), or a metal cage which is filled with bone.
  21. The bone, bone-like material or bone-filled cage is now placed into the space.
  22. An X-Ray is taken to make sure the bone implant looks appropriate in its size and the location.
  23. A titanium plate is chosen which fits over the new bone or cage. This plate has to be large enough to also cover parts of the vertebrae above and below the new bone.
  24. The titanium plate is placed over the new bone and secured with small screws into the vertebrae above and below.
  25. Another X-Ray is taken to see the “fit” of the plate and screws.
  26. The main part of the surgery is now done.
  27. The retractors are removed
  28. A drainage tube (surgical drain) is placed above the plate to allow for any bleeding to drain out from the patient.
  29. The platysma muscle is sometimes closed with stitches (sutures).
  30. The skin is closed with small stitches (sutures).
  31. Sometimes steri-strips (butterflies) are placed over the stitches.
  32. A bandage (dressing) is placed over the wound and taped down.

How long does a surgery like this take?

A corpectomy at one level in the neck takes approximately 1.5 -3 hours to complete.

What is the recovery like?

1. Patients who undergo a Cervical Corpectomy surgery are admitted to the hospital at least overnight, often for 2-3 days.

2. The recovery time is usually 6-8 weeks for a one level corpectomy. If more than one vertebra is operated on, this time could lengthen.

3. The surgeon will often restrict the amount of weight you can lift. This is done to avoid too much stress on the area of the surgery.

4. You may be asked to avoid taking anti-inflammatory medication (NSAIDS), as they can interfere with the fusion.

5. You may be asked not to smoke or be around Tabaco smoke for a period of time as nicotine interferes with fusions.

6. The surgeon will typically take another X-Ray in a few weeks after surgery to make sure the bone graft and metal plates and screws are in a good position. This will be repeated at certain intervals to see how the fusion is coming along.

7. Sometimes Physical Therapy (PT) is used to help with the neck mobility.

8. It may take 6 months to 1 year for a bone fusion to be solid. This does not mean that a patient would have pain or be very restricted in their movement during this time.

9. The symptoms (pain, numbness, weakness) from the spinal cord compression can take weeks to months to reach the maximum level of improvement. In cases where the spinal cord was compressed for a long period of time, some of the symptoms may remain.

What type of benefit can patients gain from a Cervical Corpectomy?

Patients can get relief of neck and arm pain, as well as symptoms from the spinal cord compression such as leg numbness and weakness. This can be for the long term.