Corpectomy

Corpectomy refers to the removal of one or more vertebral bodies and is followed by spinal fusion. 

Indication

• compressive myelopathy secondary to, for example, retrovertebral hypertrophic osteoarthritis, tumor, infection, severe trauma

Contraindications

• multilevel corpectomy in patients with post-laminectomy kyphosis ⁴

Procedure

Corpectomies can be performed in the cervical spine as well as the thoracolumbar spine with a number of surgical approaches including anterior/lateral, posterior and circumferential 4,5.

An anterior or posterior approach may be utilized, an anterior approach is more common ⁴. Discectomies are performed above and below the level/s for corpectomy. The width of the corpectomy depends on the degree of decompression needed by uncinate-to-uncinate is typically performed ⁴. 

Once the vertebral body is resected a spinal fusion must be carried out, and a number of alternatives exist depending on location, etiology of underlying pathology, surgeon preference and prognosis. 

A bone graft is often used to fill the space and eventually lead to complete osseous fusion ¹. An autograft from the patient's pelvic bones (most commonly, the iliac wing) or lower limb bones (most commonly, the fibula) can be used. Alternatively, a mechanical construct +/- bone graft can be inserted (e.g. titanium cage, PEEK-cage) or expandable device ^1-3. Following this additional instrumentation is required to fully stabilize the segment. Less commonly, bilateral stabilizing decompression rods are applied, without filling the post-corpectomy gap ^ref.

Complications

• neurological deficits ²
• dural tear with CSF leak
• wound infection
• graft displacement
• vertebral artery injury ⁴