Cervical corpectomy can be used for a variety of spinal disorders, including infection, neoplastic disease, and trauma, but it is most commonly used for multilevel cervical spondylosis. Single-level vertebrectomy can be carried out on patients with signs and symptoms of myelopathy, who are found on imaging to have spinal cord compression by osteophyte formation and soft-disc herniation at two adjacent levels. Three-level disease and compression can be treated by a two-level vertebrectomy or a multilevel laminectomy. A vertebrectomy should be performed if there is straightening of the spine, as progressive kyphosis is likely after laminectomy or kyphotic deformity as the cord is unlikely to move posteriorly away from the compression in the presence of kyphosis. When compression stretches four motion segments a posterior decompression is preferred, but again, in situations of kyphotic deformity a three-level vertebrectomy is suitable, and then supplemented with a posterior instrumentation to decrease the risk of graft and plate dislodgement. OPLL also usually requires at least a one-level vertebrectomy.
Regarding the operative procedure, the same approach as the ACDF described above is used. Once the correct level is confirmed the anterior longitudinal ligament over the disc spaces above and below the level to be resected is incised; the most anterior portions of the underlying discs are then removed, as is the anterior longitudinal ligament covering the front of the vertebrae. The extent of bone to be removed is then marked, the width of bony resection is usually 18
mm, but can be decreased to 15
mm at C4 or C5 level surgery to decrease the incidence of C5 nerve root dysfunction [24
]. An operating microscope is used as bony resection proceeds using a diamond burr; care is taken once the superficial portion of the body is removed as the vertebral artery lies in the middle third of the AP diameter of the vertebral body. As bony resection proceeds, the end plates of the adjacent vertebrae are also resected. The posterior longitudinal ligament is then opened taking care to lift it away from the dura, and Kerrison rongeurs are then used to resect it as far as the bony exposure. Bony reconstruction can be accomplished using an allograft, autograft, or cage system. The graft should be 2
mm longer than the length of the vertebrectomy, the AP depth is 13
mm. Distraction pins are used above and below in order to insert the construct; using a graft holder it is then hammered into place until it is flush with the anterior aspect of the adjacent vertebral bodies.
Anterior plating is then performed, and the screws are placed under fluoroscopic guidance, as this ensures accurate screw placement avoiding both the graft and the adjacent disc spaces; engagement of the posterior cortex has been shown unnecessary [25