Multilevel Corpectomy for Cervical Spondylotic Myelopathy

ABSTRACT

Multilevel corpectomy for decompressing the spinal cord to treat cervical spondylotic myelopathy has become commonplace. Correlation of preoperative radiographic findings with intraoperative anatomy will ensure adequate decompression and lessen complications. Reconstruction with cadaveric fibula or bone-filled titanium cages combined with a locking cervical plate has reduced donor site morbidity and long-term construct failure to near zero for two-level corpectomies. Three or more levels may best be reconstructed by both anterior and posterior instrumentation. One of the more common complications of this operation is hoarseness and that may be lessened with endotracheal tube deflation during retraction. Most of the complications of surgery are minor (including dysphagia), improve with time, and are well tolerated by the patient. The preoperative myelopathic gait improves in 50% and upper extremity weakness/spasticity improves in 70% of patients.

KEYWORDS

Cervical myelopathy - cervical spondylosis - corpectomy - arthrodesis - instrumentation

REFERENCES

• 1 Bohlman H, Emery S. The pathophysiology of cervical spondylosis and myelopathy.  Spine . 1988;  13 843-846
• 2 Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis.  Brain . 1972;  95 87-100
• 3 Hayashi H, Okada K, Hamada M, Tada K, Ueno R. Etiologic factors of myelopathy. A radiographic evaluation of the aging changes in the cervical spine.  Clin Orthop . 1987;  214 200-209
• 4 Edwards W, LaRocca H. The developmental segmental sagittal diameter of the cervical spinal canal in patients with cervical spondylosis.  Spine . 1983;  8 20-27
• 5 Obisesan K, Obajimi M. Radiological aging process in the cervical spine of Nigerian women.  Afr J Med Med Sci . 1999;  28 189-191
• 6 Hall E, Braughler J. Glucocorticoid mechanisms in acute spinal cord injury: a review and therapeutic rationale.  Surg Neurol . 1982;  18 320-327
• 7 Hedeman L, Sil R. Studies in experimental spinal cord trauma. 2. Comparison of treatment with steroids, low molecular weight dextran, and catecholamine blockade.  J Neurosurg . 1974;  40 44-51
• 8 Dyste G, Hitchon P, Girton R, Chapman M. Effect of hetastarch, mannitol, and phenylephrine on spinal cord blood flow following experimental spinal injury.  Neurosurgery . 1989;  24 228-235
• 9 Grum D, Svensson L. Changes in cerebrospinal fluid pressure and spinal cord perfusion pressure prior to cross-clamping of the thoracic aorta in humans.  J Cardiothorac Vasc Anesth . 1991;  5 331-336
• 10 Mayr M, Subach B, Comey C, Rodts G, Haid R. Cervical spinal stenosis: outcome after anterior corpectomy, allograft reconstruction, and instrumentation.  J Neurosurg . 2002;  96 10-16
• 11 Bernard T, Whitecloud T. Cervical spondylotic myelopathy and myeloradiculopathy. Anterior decompression and stabilization with autogenous fibula strut graft.  Clin Orthop . 1987;  221 149-160
• 12 Boni M, Cherubino P, Denaro V. et al . Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases.  Spine . 1984;  9 358-362
• 13 Eleraky M, Llanos C, Sonntag V. Cervical corpectomy: report of 185 cases and review of the literature.  J Neurosurg . 1999;  90 35-41
• 14 Emery S, Bohlman H, Bolesta M. et al . Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two- to seventeen-year followup.  J Bone Joint Surg (Am) . 1998;  80 941-951
• 15 Brown J A, Havel P, Ebraheim N. et al . Cervical stabilization by plate and bone fusion.  Spine . 1988;  13 236-240
• 16 Ebraheim N, DeTroye R, Rupp R. et al . Osteosynthesis of the cervical spine with an anterior plate.  Orthopedics . 1995;  18 141-147
• 17 Fernyhough J, White J, LaRocca H. Fusion rates in multi-level cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients.  Spine . 1991;  16 S561-S564
• 18 Fessler R, Steck J, Giovanini M. Anterior cervical corpectomy for cervical spondylotic myelopathy.  Neurosurgery . 1998;  43 257-265
• 19 Hanai K, Fujiyoshi F, Kamei K. Subtotal vertebrectomy and spinal fusion for cervical spondylotic myelopathy.  Spine . 1986;  11 310-315
• 20 Caspar W, Barbier D, Klara P. Anterior cervical fusion and Caspar plate stabilization for cervical trauma.  Neurosurgery . 1989;  25 491-502
• 21 Herman J, Sonntag V. Cervical corpectomy and plate fixation for postlaminectomy kyphosis.  J Neurosurg . 1994;  80 963-970
• 22 Hu R, Wilber R. Anterior cervical corpectomy for the treatment of complex cervical lesions.  Can J Surg . 1993;  36 85-88
• 23 Kojima T, Waga S, Kubo Y. et al . Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament.  Neurosurgery . 1989;  24 864-872
• 24 Macdonald R, Fehlings M, Tator C. et al . Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy.  J Neurosurg . 1997;  86 990-997
• 25 Saunders R, Bernini P, Shirreffs T. et al . Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation.  J Neurosurg . 1991;  74 163-170
• 26 Saunders R, Pikus H, Ball P. Four-level cervical corpectomy.  Spine . 1998;  23 2455-2461
• 27 Seifert V, Stolke D. Multisegmental cervical spondylosis: treatment by spondyloectomy, microsurgical decompression, and osteosynthesis.  Neurosurgery . 1991;  29 498-503
• 28 Shapiro S, Snyder W. Spinal instrumentation with a low complication rate.  Surg Neurol . 1997;  48 566-574
• 29 Tippets R, Apfelbaum R. Anterior cervical fusion with the Caspar instrumentation system.  Neurosurgery . 1988;  22 1008-1013
• 30 Tominaga T, Koshu K, Mizoi K. et al . Anterior cervical fixation with the titanium locking screw-plate: a preliminary report.  Surg Neurol . 1994;  42 408-413
• 31 Yonenobu K, Fuji T, Ono K. et al . Choice of surgical treatment for multisegmental cervical spondylotic myelopathy.  Spine . 1985;  10 710-716
• 32 Zdeblick T, Bohlman H. Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting.  J Bone Joint Surg (Am) . 1989;  71 170-182
• 33 Apfelbaum R, Kriskovich M, Haller J. On the incidence, cause, prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery.  Spine . 2000;  25 2906-2912
• 34 Hanai K, Inouye Y, Kawai K. et al . Anterior decompression for myelopathy resulting from ossification of the posterior longitudinal ligament.  J Bone Joint Surg . 1982;  64B 561-564
• 35 Saunders R. On the pathogenesis of the radiculopathy complicating multilevel corpectomy.  Neurosurgery . 1995;  37 408-412
• 36 Shapiro S. Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy.  J Neurosurg . 1996;  84 161-165
• 37 Shapiro S, Connolly P, Donnaldson J, Abel T. Cadaveric fibula, locking plate, and allogeneic bone matrix for anterior cervical fusions after cervical discectomy for radiculopathy or myelopathy.  J Neurosurg . 2001;  95 (suppl 1) S43-S50
• 38 Whitecloud T. Complications of anterior cervical fusion.  Instr Course Lect . 1976;  27 223-227
• 39 Espersen J, Buhl M, Fode K. et al . Treatment of cervical disc disease using Cloward's technique. I. General results, effect of different operative methods and complications in 1,106 patients.  Acta Neurochirurgica . 1984;  70 97-114
• 40 Das K, Couldwell W, Sava G, Taddonio R. Use of cylindrical titanium mesh and locking plates in anterior cervical fusion [technical note].  J Neurosurg . 2001;  94 (suppl 1) S174-S178
• 41 Majd M, Vadhva M, Holt R. Anterior cervical reconstruction using titanium cages with anterior plating.  Spine . 1999;  24 1604-1610
• 42 Shultz K, McLaughlin M, Haid R. et al . Single-stage anterior posterior decompression and stabilization for complex cervical spine disorders.  J Neurosurg . 2000;  93 214-221
• 43 Brodke D, Gollogly S, Mohr A. et al . Dynamic cervical plates: biomechanical evaluation of load sharing and stiffness.  Spine . 2001;  26 1324-1329