7 Multiple-Level Cervical Vertebrectomy (Corpectomy) and Stabilization Using Cortical Bone

1. Supine with neck in the neutral position (Fig. 7–1).

2. Head halter or skeletal traction is applied.

3. Cervical traction with 10 lbs (fractures may require less traction).

4. Obtain anteroposterior (AP) and lateral views of the spine to assure correct position of the vertebral column.

Incision Options

1. Transverse

2. Oblique

It is possible to expose up to three levels through a horizontal skin incision, but the amount of retraction necessary for this exposure is sometimes excessive and can be difficult in larger patients. The incision we prefer is an oblique incision along the medial border of the sternocleidomastoid on the patient’s right side (Fig. 7–2). The incision can be extended superiorly to the level of the vertebral body of C2 and inferiorly to the body of C7 and the C7-T1 disc space.

Dissection

After the skin incision is made and the incision is carried down to the level of the platysma muscle, the platysma is incised in line with the incision. This is followed by identification of the medial border of the sternocleidomastoid muscle, which is mobilized through the length of the skin incision to maximize soft tissue relaxation. The interval between the carotid sheath, esophagus, and trachea is identified and developed. Blunt dissection is performed through this interval, gently dissected proximally and distally. Dissection is performed using a single digit, a Kitner, or blunt instrument. Care is taken not to injure the neurovascular structures laterally or the esophagus and trachea medially. Dissection is carried down to the anterior portion of the cervical spine. Blunt retractors are placed, which allows excellent exposure with little danger of injury to the carotid sheath or esophagus. The precervical fascia is exposed and incised. The anterior portion of the vertebral column is now exposed. The longus colli muscles are identified and elevated laterally. Hemostasis is achieved as this process is performed. Self-retaining blunt retractors are inserted (Casper), further exposing the anterior column. It is important to obtain hemostasis as the exposure proceeds, allowing better visualization of the operative field.

Points of Interest

1. Blunt dissection decreases the chance of soft tissue injury.

2. Following the fascial planes minimizes injury.

3. It may be necessary to release the omohyoid muscle.

4. Headlight illumination allows excellent visualization of the operative field. Magnification with loupes or the operative microscope should be utilized.

5. Retraction can be performed using a blunt self-retaining retractor, which provides better soft tissue protection.

Decompression

Related posts:

Posterior Cervical Laminectomy and Fusion Odontoid Fixation Anterior Thoracoscopic Release for Spinal Deformity Anterior Cervical Corpectomy Anterior Lumbar Interbody Fusion Total Lumbar Disc Replacement Using the SB III Charite Prosthesis

Stay updated, free articles. Join our Telegram channel

Join