Anterior Cervical Corpectomy

surgical approach for anterior cervical spine vertebral body decompression

1. Start with the Great name of ALLAH, the most beneficial and the most merciful

2. Anterior cervical CorpecTomy Dr Zeeshan Nasir

3. Indication for corpectomies : Corpectomy is usually performed when Diskectomy is not sufficient to decompress. Degenerative cervical spondylotic myelopathy Tumor involving vertebral body and neural elements Traumatic cervical spine fracture Osteomylitis with epidural abscess & neural compression OPLL

4. Position: Supine Pressure point should be padded, especially ulnar Pad between scapula Patient with myelopathy, over extension should be avoided Shoulder should be tapped, but avoid over traction

5. Localize with flouroscopy or external marker to design Level of incision Left side most approached to reduce the damage of recurrent laryngeal nerve Incision can be made transverse or longitudinal

6. Dissection under platysma, superiorly and inferiorly, allows better mobilization of tissue

7. Identification of medial border of SCM

8. Metzenbaum scissors

9. Dissection of areolar plane, between medial border of SCM and medial structures Carotid artery should be palpate lateral to plane of dissection

10. Retract the medial structures from SCM to expose para Vertebral facsia

11. Incised the fascia Use kittner to sweep fascia superiorly and inferiorly

12. Confirm the level of spine by using per operative marker Avoid the marker to be placed on vertebral disc.

13. Electrocautery and periosteal Elevator. Dissect the Longus colli laterally from Medline attachment

14. Place self retaining retractor deep to the Longus colli Periodically Deflate the cuff of ETT To minimize esophagus and tracheal edema Put Casper distraction pin is placed Into vertebral bodies above and below the level Of interest and Gentle distraction applied

15. Disk above and below the level of interest Should be incised and Removed with curettes and pituitary ronguers

16. Burr is used to thin vertebral body UpTo posterior longitudinal ligament Or leksell rongur can be used to harvest the bone if it’s not pathological

17. PLL carefully Pierce with small hook or curettes Small karrison rongur can be used to lift the PLL Away from dura .

18. Lateral Decompression ( forminotomy ) usually done at unconvertable joint The uncus can be thin by burr and remove with the help of micro curettes Or karrison rongur

19. Strut graft or cage filled with allograft Can be placed in the defect after contouring of vertebral end plates.

20. If the integrity of posterior elements is intact then only the anterior cervical plates provide greater benefits Some uses rigid plates or other uses dynamic cervical plates

21. Complications Wound infection Horsness Temporary or permanent Dysphagia Nerve root injury or spinal cord injury Acute airway obstruction from swelling or hematoma CSF leakage Vertebral artery injury Graft dislodgment and instrumentation failure

22. Post Op care Intubated for 24 hours External immobilization of cervical spine Physiotheraphy Ensure patient is tolerating oral intake

23. Outcome Greater then 98 % fusion rate Improvement of radicular and myelopathy symptoms 86% For bedridden patients, clinical improvement noted 60% after surgery