Anterior Cervical Corpectomy, Fusion and Instrumentation
An actual surgery done by Jeff Fischgrund, M.D.
An anterior cervical corpectomy, fusion and instrumentation, is usually performed for patients who have pressure on their nerves or spinal cord in their neck. This pressure can lead to pain, weakness or numbness in the arms and occasionally in the legs as well. If non-operative treatment such as medications and therapy are ineffective, patients may require surgery in order to relieve the pressure off their spinal cord and nerves. This procedure is done under general anesthesia, with hospital stays ranging from 1-3 days.
The procedure begins with a skin incision on the left or right side of the neck. Below the skin, the trachea and esophagus are towards the midline, while the carotid artery and jugular vein is towards the outside. In between these structures is the interval where the anterior portion of the spinal bones (vertebrae) can be felt. Retractors are placed to hold aside the muscles, as well as the other vital structures in the neck. This allows visualization of the vertebrae, as well as the disc spaces in between the vertebrae. A needle is frequently placed in one disc space and an x-ray obtained to confirm the correct level of the surgery. A sharp scalpel is then used to cut through the disc. The disc is then removed with a "grabbing" instrument called a pituitary rongeur. Frequently, the disc is removed above and below the vertebrae which is causing compression on the nerves. After the discs are removed, a motorized instrument called a bur is used to remove the anterior portion of the vertebral body. The bur as well as other sharp instruments are used to remove bone until the covering over the spinal cord (dura) is seen. By removal of this bone, the pressure on the spinal cord and nerves is removed.
Once the decompression is complete, some type of bone graft or metal cage needs to be inserted in this space. In this example, a piece of bone called a fibula has been removed from a cadaver and cut to the appropriate size and shape. The fibula is then placed in the space where the bone has been removed, between the two adjacent, normal vertebral bodies. In order to provide more stability, a thin metal plate is placed over the fibular graft. Screws are then placed in the normal bone above and below the area which has been decompressed. Most plates and screws are made of a type of metal called titanium
This procedure usually takes 2-4 hours and most patients notice significant relief of their arm or leg complaints within a short period of time. After discharge from the hospital, many patients need to wear a hard cervical collar for 6-12 weeks. Following removal of the collar, rehabilitation with physical therapy is frequently necessary for several additional weeks.