Indications
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Correction of cervical kyphotic deformity
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Decompression of the cervical spinal cord in degenerative spondylotic myelopathy
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Excision of ossified posterior longitudinal ligament (PLL) that often bridges past disk spaces and cannot be adequately removed with diskectomies alone
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Treatment of osteomyelitis that fails nonoperative management
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Resection and stabilization of vertebral body tumor
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Management of traumatic fractures of the subaxial spine, such as vertebral body burst fracture, or as part of circumferential stabilization with fracture-dislocations
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Facilitation of fusion in cases with multiple contiguous levels of cervical disk herniation—a mixture of diskectomies and a corpectomy can facilitate fusion by decreasing the total number of end plates through which fusion must occur
Contraindications
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Previous radiation to the anterior neck obscures dissection planes.
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Multiple prior anterior surgeries and severe anterior soft tissue injury are contraindications.
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Aberrant vertebral artery anatomy is a relative contraindication and requires attention to width of the corpectomy trough.
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Chin on chest deformity is best treated with cervicothoracic fusion and T1 osteotomy.
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Anterior bony ankylosis secondary to degenerative or inflammatory disease is a contraindication.
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This procedure cannot be done in patients with medical contraindications to general anesthesia.
Planning and positioning
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The patient is positioned supine on a radiolucent table.
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The patient is asked to extend the neck. If neck extension is adequate, general endotracheal anesthesia is administered. Often, the patient has severe myelopathy and cord compression requiring awake or fiberoptic intubation.
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A rolled sheet is placed across the shoulder to facilitate extension, and the head is supported on a foam donut. In trauma or cervical spine instability, alignment should be verified with fluoroscopy.
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Intraoperative neurophysiologic monitoring, such somatosensory evoked potentials and motor evoked potentials, may be used.
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The patient’s arms are tucked to the side, and the shoulders are taped down to facilitate visualization of the lower cervical spine under fluoroscopy.
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Levels of pathology are as follows:
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C1-3—1 cm below the angle of the jaw
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C3-4—hyoid bone
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C4-5—top of the thyroid cartilage
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C5-6—bottom of thyroid cartilage
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C6-7—top of cricoid cartilage
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C7-T1—bottom of cricoids cartilage
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The surgery can be performed from a right-sided or left-sided approach based on the surgeon’s handedness (i.e., right-handed surgeons prefer a right-sided approach and vice versa), and based on the side contralateral to the arm with more severe radiculopathy.
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If iliac crest autograft is being harvested, a pillow is placed under the buttock. The incision is planned lateral to the anterior superior iliac spine to avoid inadvertent damage to the lateral femoral cutaneous nerve.
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Draping is done in the usual manner, with the iliac crest incision site being draped separately and covered.
Procedure
