Table of Contents
Introduction
The spine, or the backbone of the human body, truly supports the human body. It is composed of bony structures of vertebrae. It not only helps maintain posture but also helps with other functions like locomotion and limb movements. Also, the neural portion of the spine or the spinal cord helps in sensory or motor functions. However, in recent times, researchers have observed a rise in spine disorders. Almost 15 million people in the world suffer from spinal cord-related diseases. As a result, several surgical techniques are used to cure such conditions.
What Is Corpectomy?
A corpectomy is a surgical procedure that helps to reduce the pressure on the spinal cord or nerve arising from the spine. The term corpectomy is derived from two Latin words, corpus and ectomy, which mean removing the body parts. Corpectomy surgery stabilizes the spine and helps in spine regeneration with bone grafts. This procedure removes a portion of the vertebral body and the intervertebral disk through the anterior approach.
After removing the damaged structure, a cage is placed in the place of the damaged structure. Also, the function of this cage is to support the intervertebral space. In general, these corpectomy cages are made up of titanium mesh or bioactive mesh-like polyetheretherketone (PEEK) or carbon fiber.
The corpectomy procedure is usually performed in the neck region to cure abnormalities in the neck region. Such a procedure is known as a cervical corpectomy. However, such procedures may be performed for thoracic and lumber vertebrae. Those surgeries are known as thoracic corpectomy and lumbar corpectomy.
What Are the Indications of Corpectomy?
The indications for corpectomy are;
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Spinal Cord or Nerve Root Compression: Compression of the spinal cord and nerve root is one of the major causes of this surgery. Such compression is mainly seen in degenerative disk disorders. In such cases, conditions like osteoporosis lead to low bone mineral density. As a result, the softening of the vertebrae causes compression fracture. The gap between vertebrae and intervertebral space is reduced, compressing the nerves and nerve roots arising from the spinal cord.
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Vertebral Body and Disc Damage: The vertebral body and disc can be damaged by several conditions. Stress and compression fractures of the vertebral body are one of the main causes of intervertebral disc injury and nerve injury. Osteoarthritis and rheumatoid arthritis also damage the vertebral body.
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Structural Abnormalities: Structural abnormalities may occur due to different causes. Congenital defects of the spine may be seen in conditions like Ehlers-Danlos syndrome (a type of congenital connective tissue disorder) and Saethre-Chotzen syndrome (congenital malformation of skull bone). All the conditions lead to situations like lordosis (backward bending of the spine), kyphosis (forward bending of the spine), and kyphoscoliosis (forward and lateral bending of the spine).
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Tumor or Neoplastic Involvement: Benign and malignant tumors that involve the vertebrae may cause damage to the spine and spinal cord. Also, such conditions may cause cervical stenosis (narrowing of the cervical spinal column).
How Is a Corpectomy Surgery Performed?
The corpectomy surgery is performed under general anesthesia. As already discussed, the cervical corpectomy is the most widely used surgical procedure. In this procedure, the anterior approach is used. The patient is placed in a supine position (the person lies on the back). The surgeon keeps the patient's neck in a natural position. In some cases, a support or a towel is kept under the neck to keep the spine's natural curvature intact. Also, the shoulders of the patient may be pulled back and down using wide tape to expose the neck on both sides properly.
Usually, the surgeon makes a transverse incision along the natural crease marks on the neck. The average length of the incision is almost three inches, and it is usually placed at the front and side portions of the neck. The surgeon gradually moves to the cervical spine through anatomical structures like muscles, trachea, esophagus, blood vessels, and nerves.
After reaching the desired level, the surgeon decompresses the affected parts of the spinal cord and the intervertebral disk.
After this, the damaged parts of the herniated disk are removed. The surgeon then removes the body portion of the affected vertebrae. A high-speed drill removes the major portion of the vertebral body, keeping only a thin portion.
During the procedure, lateral fluoroscopy is used to assess the actual portion of the vertebrae, after removing the vertebral body, the cage, and the distractors. These structures not only help to maintain the proper anatomical position of the spine but also stabilize it. Bone grafts are used at the surgical site to regenerate the bone.
Usually, patients require a five- to seven-day hospital stay for such surgery. After this, a brief period of six to eight weeks of rest is required. During this period, restricted movement and neck support are given. Following this, patients may start gradually moving the neck.
What Are the Complications of Corpectomy Surgery?
Following the surgery, the patients may face the following complications;
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Difficulty in swelling is one of the most common complications after surgery. This may happen due to anatomical structures and esophagus injury during surgery.
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One of the most serious complications with this surgery is the perforation of the esophagus.
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Another severe complication associated with this surgery is the injury to the laryngeal nerve. Such injury causes the voice's hoarseness and difficulty in breathing and swallowing.
Conclusion
Structural damage to the vertebral body is caused by conditions like osteoporosis or fracture of the vertebrae. Such damage leads to spinal cord compression and neural damage. In the corpectomy procedure, the anterior approach is used to reduce the pressure on the nerve. In this surgery, the damaged vertebral body is removed, and a cage is placed to support and stabilize the spine.
