What is a Corpectomy?
A Corpectomy is a surgical procedure that involves removing either only a portion or all of the vertebral body is called a Corpectomy. This operation is usually performed to decompress or remove pressure from the spinal cord and the nerves. Corpectomy is often done in combination with another procedure to remove all or part of a vertebral disc.
Following the removal of a vertebral body, a vertebral fusion is performed to add stability to the spine. Removing a vertebral body creates a gap or space in the spinal column that needs to be filled. To do this, a portion of bone is taken from one of the patient's legs or the pelvis and grafted in. This bone graft will separate the vertebrae that are left on either side of the gap. As the spine heals, the vertebrae will eventually grow together over the bone graft and fuse.
In Corpectomy, the vertebral bodies and the adjacent vertebral discs are removed to alleviate the pressure on the spinal cord, which is causing spinal stenosis and myelopathy. A Corpectomy can also be used to treat fractures, tumors, infections or spinal deformities. The Latin word “corpus” means body and “ectomy” means to remove.
Indication and Procedure
Corpectomy can be performed on any part of the spine, either the cervical spine, thoracic spine, or the lumbar spine. Corpectomy is usually indicated when the cervical disease involves more than just the disc space.
It is often done for multi-level stenosis with spinal cord compression caused by bone spur growth. The approach of corpectomy is similar to discectomy, although a larger and more vertical incision in the neck will often be used to allow more extensive exposure. The surgeon then performs a discectomy at either end of the vertebral body that will be removed.
The posterior longitudinal ligament is often removed to allow access to the cervical canal and to ensure complete removal of the pressure on the spinal cord or its nerve roots. A bone graft is then inserted into the space to allow for a fusion of the bone segments into one long bone. This graft may either be an autograft or an allograft. Alternatively, “cages” made of titanium or synthetic materials may be used as an alternative to bone grafts.
Risks of Corpectomy
Corpectomy is a more extensive procedure and relatively more complex to perform than other spinal operations. The risks and possible complications of the Corpectomy are statistically greater and should always be discussed with the patient prior to the Corpectomy. Some of the complications of Corpectomy may include:
- Nerve root damage
- Permanent damage to the spinal cord
- Graft dislodgement
- Continued pain
- Complications secondary to anesthesia.
The risk of Corpectomy that most spine surgeons worry about the most is the compromise of the spinal cord that can lead to complete or partial quadriplegia or paralysis.
To help manage the risks during a Corpectomy, the spinal cord function is monitored by somatosensory evoked potentials, which generates a small electrical impulse in the arms and legs. It measures the corresponding brain response and records the length of time it takes the signal to reach the brain.
Any marked slowing in the length of time may indicate the compromise of the spinal cord. There is also a slight risk during the removal of the vertebral body that the vertebral artery is injured. This can lead to a cerebrovascular accident or stroke or a life-threatening bleeding.
This risks of Corpectomy are more significant in certain instances of tumor removal or vertebral infections.With these risks involved, Corpectomy is reserved for those patients with significant spinal cord problems.
Post-Operative Care for Corpectomy
Recovery after Corpectomy surgery can be a slow process. Postoperative pain control will be achieved with the use of intravenous or oral pain medication. Rehabilitation therapy for two to three months is usually recommended for Corpectomy. Once pain and inflammation are controlled, active treatments are slowly introduced to help tone and control the muscles that stabilize the neck and the upper back. Full recovery from Corpectomy may be expected to take up to one year.