Definition and Overview

A corpectomy is a surgical procedure wherein a damaged vertebral body is removed, either partially or completely, to decompress the spinal cord. The term was derived from a Latin word corpus vertebrae, which translates to a vertebral body. In most cases, it is associated with discectomy and is often followed by another procedure called vertebral fusion. The most common type of corpectomy is cervical corpectomy, which removes the vertebrae in the neck area.

Who Should Undergo and Expected Results

A corpectomy is recommended for patients with a compressed spinal cord caused by damaged vertebrae and intervertebral discs. It is often performed on patients suffering from:

  • Spinal stenosis, including multi-level cervical stenosis – This refers to the narrowing of the open spaces in the spine causing increased pressure on the spinal cord and the nerves around it. This most often affects the lower back and the cervical spine.

  • Osteophytes – An osteophyte is a bone spur that forms along the margins of the joints.

  • Sciatica – Sciatica is a spinal condition that develops when the sciatic nerve becomes compressed or irritated. It can cause tingling, weakness, and numbing of the lower back and legs.

  • Herniated disc – A herniated disc is a spinal problem wherein one of the discs in between the individual bones of the vertebrae becomes damaged, causing it to break open or to bulge. It is thus also called a bulging disc. It is one of the most common causes of low back pain, which occurs if the bulging disc compresses a nerve. It can also cause problems with bladder and bowel control.

  • ScoliosisScoliosis is a common condition wherein the spine twists and curves abnormally to the side. It can affect both infants and adults but is more predominant among children between 10 and 15 years of age.

  • Spondylolisthesis – Spondylolisthesis is a spinal problem wherein a spinal vertebra slips out of its correct place. It most commonly affects the bones in the lower vertebral body.

A corpectomy, which can relieve symptoms including lower back and neck pain, is similar to a discectomy. Both surgeries can be used to treat many types of spinal conditions. However, a corpectomy is more extensive because it removes the vertebrae, whereas a discectomy only removes discs and bone spurs.

Due to the extensive nature of the procedure, a corpectomy is not the primary treatment for the conditions mentioned above. Prior to recommending it, most doctors resort to conservative remedies, including physical therapy and prescription pain medications. In many cases, such measures are effective and help patients avoid the extensive risks of a corpectomy. However, if the patient’s spinal problems are putting their entire spinal cord at risk of damage, a corpectomy can be highly beneficial.

A corpectomy is also recommended when:

  1. The patient is not responding to conservative treatments

  2. The patient is experiencing severe pain

  3. The spinal cord is severely compressed causing patients to experience:

  • Loss of bladder control

  • Loss of bowel control

  • Difficulty walking

  • Impaired hand coordination

  • Progressive neurologic deficit resulting in numbness and weakness in the arms and legs

How is the Procedure Performed?

A corpectomy is performed under general anaesthesia and involves making an incision near the part of the spinal cord where the damaged vertebrae and discs are located. For the procedure, tissues and muscles in the affected area are moved aside to gain access to the spinal bones. All damaged vertebrae and discs are then removed, immediately removing the pressure on the spinal cord and the nerves surrounding it.

To allow the surgeon to completely remove the vertebral body, the posterior longitudinal ligament may also be removed.

After a corpectomy, the surgeon will perform a discectomy on each end of the vertebral body. This is often followed by a spinal fusion, which helps keep the spinal column stable by replacing the removed vertebrae and discs with implants. Implants can be bone taken from the patient’s own body or bone from a bone bank.

The bone graft is inserted into the space where the vertebral body was taken from and fused in place using titanium screws and plates. Over time, the graft fuses with the patient’s real bones and provides long-term stability to the spine.

After undergoing a corpectomy, patients are often advised to stay in the hospital overnight. They are then discharged the following day but are asked to return for follow-up checks. They normally have to return after seven days for the removal of the surgical dressing and after four to six weeks for a spine x-ray to check if the bone and the implant are fusing together properly.

On average, patients take six to eight weeks to recover from a corpectomy. During this period, they may be given oral pain medications and muscle relaxants.

In some cases, patients may also need physical therapy and may have to wait for up to six weeks before they can perform neck exercises to allow for proper bone healing.

Possible Risks and Complications

A corpectomy is one of the more serious and difficult spinal surgeries. Its risks and complications include:

  • Damaged spinal cord, which can lead to complete/partial quadriplegia (paralysis of all four limbs)

  • Nerve root damage

  • Infection

  • Bleeding

  • Chronic pain

  • Damaged trachea or oesophagus

The risks of a corpectomy are significantly greater compared to those of a discectomy alone. Of the above risks, spine surgeons are most concerned about the effects of the procedure on the spinal cord. Due to its potential effects on the spinal cord, a corpectomy is often only performed on patients with significant spinal cord problems.

References:

  • “Anterior cervical corpectomy.” The Spine Hospital at the Neurological Institute of New York. http://columbiaspine.org/treatments/anterior-cervical-corpectomy/

  • Gao R, Yang L, Chen H, Liu Y, Liang L, Yuan W. “Long term results of anterior corpectomy and fusion of cervical spondylotic myelopathy.” April 13, 2012. https://doi.org/10.1371/journal.pone.0034811

  • Patel KR, Szczodry M, Neckrysh S, Siemionow K. “Anterior cervical corpectomy and fusion for blastomycosis causing destruction of C6 vertebra: A case report.” Journal of Medical Case Reports. 2015; 9:271. https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-015-0762-x

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