There are several techniques with which to approach surgically a cervical compressive pathology causing cervical myelopathy. The goal of all treatments is to decompress the cervical neural structures. Vertebrectomy is reserved for those patients with ventral spinal cord compression in whom disc space and osteophyte excision above and below the vertebra is inadequate to decompress the ventral spinal cord. Single level cervical corpectomy is a technique addressed to the patient with cervical myelopathy with ventral spinal cord compression caused by:
- ossified posterior longitudinal ligament (OPLL)
- osteophytes in the posterior wall of the cervical vertebral body
- soft disc herniation in two adjacent motion segments
Multiple level cervical corpectomies are preferred in patients with spinal cord compression at three adjacent motion levels showing at lateral cervical x-rays and/or sagittal computed tomographic (CT) scans: a straightening of the normal cervical curvature or kyphotic deformity of the same segment. This approach allows not only the resolution of spinal cord compression but also a restoration of physiological cervical lordosis.
When there are four adjacent motion levels involved in the spinal cord compression it is necessary to consider whether there is a cervical kyphotic deformity. The coexistence of kyphosis makes these patients appropriate candidates for a three-level vertebrectomy and a supplemental posterior instrumentation for preventing graft and plate dislodgement.
- ossified posterior longitudinal ligament (OPLL)
- osteophytes in the posterior wall of the cervical vertebral body
- soft disc herniation in two adjacent motion segments
Multiple level cervical corpectomies are preferred in patients with spinal cord compression at three adjacent motion levels showing at lateral cervical x-rays and/or sagittal computed tomographic (CT) scans: a straightening of the normal cervical curvature or kyphotic deformity of the same segment. This approach allows not only the resolution of spinal cord compression but also a restoration of physiological cervical lordosis.
When there are four adjacent motion levels involved in the spinal cord compression it is necessary to consider whether there is a cervical kyphotic deformity. The coexistence of kyphosis makes these patients appropriate candidates for a three-level vertebrectomy and a supplemental posterior instrumentation for preventing graft and plate dislodgement.
References
- Matz PG, Pritchard PR, Hadley MN. Anterior Cervical Approach for the Treatment of Cervical Myelopathy. Neurosurgery 60 [Suppl 1]:S64 -S70, 2007.
- Douglas AF, Cooper PR. Cervical Corpectomy and Strut Grafting.Neurosurgery 60[Supp l]:S137 -S142, 2007.
- Law MD Jr, Bernhardt M, White AA 3rd: Cervical spondylotic myelopathy: A review of surgical indications and decision making. Yale J boil Med 66: 165-177, 1993.
- Matz PG, Wolff CL 3rd, Hadley MN: Management of cervical kyphotic deformity. Seminars in Neurosurgery 14:55-60, 2003.
- Schultz KD jr, McLaughlin MR, Haid RW Jr, Comey CH, Rodts GE jr, Alexander J: Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders. J Neurosurg 93 [Suppl 2]:214-221, 2000
