Corpectomy Procedure- Neck Surgery
The patient undergoing a corpectomy is likely to have their head held still in a clamp during the procedure, and may be intubated under general anaesthetic in order to maintain the position of the neck. It is important that the surgeon positions the patient correctly so as to avoid any complications during or after the operation such as epidural compression and vocal cord injury. The patient’s cervical spine will usually be slightly extended or neutral, with care taken to avoid excessive extension or flexion.
The surgeon makes either a transverse incision in the neck in the anterior cervical triangle or an oblique incision along the medial border of the sternocleidomastoid muscle. These two options have slightly different results cosmetically, with the former less noticeable usually after neck surgery. However, the approach may differ depending on whether the surgeon is right or left-handed as the cervical spinal area contains complex structures that require easiest access so as to avoid risk of injury during the procedure. A transverse incision grants access from C2 to T1.
Entering the Neck
The surgeon identifies the carotid artery, the trachea, and the oesophagus, taking care to move them out of the way or avoid them to minimize potential trauma. The surgeon will open up access to the problematic vertebra and often uses a radiograph to confirm the correct spinal level. The longus colli muscles may be cut to allow access to the vertebrae. The surgeon will remove the disc space next to the vertebra and perform a partial discectomy. Then the bone will be excised in order to decompress the cervical spine with any bone that is removed saved to use in the fusion procedure which may follow the corpectomy and cervical discectomy. The space left by the corpectomy (called a corpectomy trough) is usually around 15 or 16mm. This is sufficient space, along with the removal of osteophytes to allow the cervical spinal cord and nerves to be free from compression.
Following on from the completion of the corpectomy, the surgeon with prepare and position a strut bone graft to consolidate the cervical spine and retain rigidity and strength after he removal of the vertebral body. An autograft may be used, where the patient has a small amount of bone excised from their hip during the same procedure. Sometimes a surgeon may favor a bone fragment taken from the fibular instead. If the patient’s own bone is not to be used then the surgeon will use either bone from a bone bank or a titanium or carbon fiber mesh for reconstruction. The graft’s position in the anterior cervical spine means it is more likely to fuse due to the compression in this area, as opposed to the posterior spine which is under tension. This makes an allograft commonly the preferred option as it reduces the risks associated with harvesting bone from the patient, such as pain at the harvest site, adjacent bone fracture, nerve damage, and vascular injury (Swank, 1997). The surgeon will secure each bone graft using a titanium plate with cancellous bone screws.
Closing up the Incision
Once the plate has bee fitted the retractors and other surgical devices will be removed and the tissues and muscles allowed to slip back into position. The surgeon will then close up the incision and it will be covered with a dressing. The patient will have a hard cervical collar fitted which they will have to wear for a number of weeks. Halo brace immobilization may be necessary, but is rare. The patient will be taken to recovery and allowed to come round from the anaesthetic.
Next read about: What happens after a Corpectomy