CERVICAL CORPECTOMY AND STRUT GRAFT

Anatomical Parts of the Cervical Spine Relevant to a Cervical Corpectomy

To comprehend the symptoms and treatment options, including a cervical corpectomy, it’s essential to understand the key anatomical components of the cervical spine.

Vertebrae

The cervical spine consists of seven vertebrae, labeled C1 to C7. These bones form the bony structure of the neck and protect the spinal cord.

Intervertebral Discs

Located between each vertebra, these discs act as cushions, absorbing shock and allowing flexibility in the neck.

Spinal Cord and Nerve Roots

The spinal cord runs through the vertebrae, and nerve roots branch out from the spinal cord, transmitting signals between the brain and the rest of the body.

Facet Joints

These small joints between the vertebrae facilitate spine movement and maintain stability.

Ligaments

Ligaments connect the vertebrae and provide additional stability. Key ligaments include:

• Anterior longitudinal ligament: Runs along the front of the vertebrae.
• Posterior longitudinal ligament: Runs along the back of the vertebrae.
• Ligamentum flavum: Connects the laminae of successive vertebrae.

Understanding these anatomical structures is vital for grasping how a cervical corpectomy addresses issues within the cervical spine.

Learn more about the anatomy of the cervical spine.

Rationale

As patients consider undergoing cervical spine surgery, it’s crucial to understand both the delicacy of operations involving the spinal cord and the inherent risks involved. Neck operations are always regarded as extremely delicate and potentially dangerous due to the proximity to the spinal cord. Before proceeding with this type of surgery, patients should thoroughly discuss the risks and benefits of the procedure with their doctor. This ensures that they fully comprehend and consent to the treatment planned.

During the surgery, specialized measures are taken to monitor the spinal cord’s function, to minimize risks and enhance safety. One such measure is the use of  Somatosensory Evoked Potentials (SSEP). This technique involves generating a small electrical impulse in the arms or legs, measuring the corresponding response in the brain, and recording the time it takes for the signal to travel to the brain. Monitoring these signals during surgery is crucial as any significant slowing in signal transmission may indicate a potential compromise of the spinal cord. This real-time monitoring helps surgeons make immediate adjustments to the surgical procedure, thereby increasing the safety and success rate of the operation.

Understanding these precautions and the technical aspects of how doctors monitor spinal cord function during surgery can provide patients a reassurance about the safety measures in place, helping patients to make informed decisions about their healthcare.

Risks

Like all surgical procedures, operations on the neck may generate complications. Because the surgeon operates around the spinal cord, neck operations are always considered extremely delicate and potentially dangerous. Before having this procedure, patients should take the time to fully review the risks associated with cervical spine surgery with their doctor — making sure they agree and understand the risks and the benefits of the procedure planned for their treatment.

With any surgery, there is a risk of complications. When surgery is done near the spine and spinal cord, these complications can be very serious. Complications could involve subsequent pain, impairment, and the need for additional surgery. It’s essential to discuss these potential complications with your doctor before undergoing a cervical corpectomy. The list of complications provided here is not intended to be exhaustive and is not a substitute for a conversation about the risks of surgery with your doctor. Only your doctor can evaluate your condition and inform you of the specific risks of any medical treatment they recommend.

One of the most concerning risks involves the potential compromise of the spinal cord, which can lead to complete or partial quadriplegia. It’s crucial to recognize that anterior cervical corpectomy surgeries are typically undertaken in cases of significant spinal cord problems, inherently placing the cord at greater risk during surgery, regardless of the surgeon’s skill and finesse.

Mitigating Risks

To mitigate this risk, Somatosensory Evoked Potentials (SSEP) are often employed during surgery. SSEPs work by generating a small electrical impulse in the arms or legs, measuring the corresponding response in the brain, and recording the time it takes for the signal to travel. A noticeable delay in this response time might suggest a compromise of the spinal cord.

Additionally, Surgeons need to be careful because of the risk of injuring the vertebral artery, which runs alongside the spine. Damage to this artery during the removal of the vertebral body can lead to a cerebrovascular accident, commonly known as a stroke, or cause life-threatening bleeding. This risk becomes particularly pronounced in surgeries involving tumor removal or the presence of vertebral infections.

Understanding these specific risks and discussing them thoroughly with your healthcare provider can help you make an informed decision about proceeding with an anterior cervical corpectomy. This comprehensive understanding provides for peace of mind, but also for anticipating and managing potential complications.

Surgical Procedure

During an anterior cervical corpectomy surgery, the surgeon focuses on accessing and relieving pressure on the spinal cord and nerve roots. Here’s a breakdown of the procedure:

Incision and Exposure:

• The process begins with the surgeon making a precise incision in the front of the neck beside the trachea (windpipe). Then the surgeon makes an incision Subsequently, the muscles are moved to the side and the arteries and nerves become protected unlike a simple discectomy which uses a smaller cut, a larger, more vertical incision is utilized for better visibility and access.

Removal of Vertebrae and Discs:

• Upon reaching the front of the spine, the surgeon uses an X-ray to identify the correct vertebrae and discs. The surgeon identifies the vertebral bodies and discs causing the problems and removes them back to the spinal cord. Bone spurs extending from the back of the vertebrae toward the spinal canal are also removed.  Disc spaces above and below the targeted vertebra, such as C4-C5 and C5-C6 if the C5 vertebral body is being removed, are carefully dissected to facilitate this. Special care reduces the risk of damaging the spinal cord and nerve roots. 

Accessing the Spinal Canal:

• Once the vertebral body becomes excised, the surgeon often removes the posterior longitudinal ligament. This step becomes crucial as it allows unobstructed access to the cervical canal and ensures that all pressure is alleviated from the spinal cord and nerve roots.

Reconstruction:

• Once the removal of the vertebrae and discs takes place, the created space needs filling. Doctors typically implant a graft of bone into this space. In addition, the section of bone graft works like a “strut” to support the spine. The formation of the strut can take place by taking bone from your hip (pelvis) or the fibula bone in your leg.  Bone taken from your own body refers to an autograft. Your surgeon may also use an allograft, which refers to bone taken from a source other than your body and stored in a bone bank.

By following these meticulous steps, the surgeon aims to improve spinal function and alleviate associated symptoms.

Learn more about the use of a bone graft.

Alternatives to Strut Grafts in Spinal Fusion

When it comes to spinal fusion, strut grafts aren’t the only option for reconstructing the spine after a corpectomy. Modern surgical techniques offer several alternatives to ensure stability and support.

Titanium Cages

One popular alternative is the use of titanium cages. These cages are robust and durable, offering significant advantages over traditional bone grafts. They act as scaffolding to maintain the spinal column’s structure and are designed to adapt well to the body’s natural rhythms.

Synthetic Materials

In addition to titanium, surgeons can use cages made from other synthetic materials. These options often provide similar support and stability without relying on donor bone. They are especially beneficial when allograft and autograft options are limited or unsuitable.

Bone Graft Morsels

When cages are used, they are frequently filled with morsels of bone graft. These bone graft pieces often come from the patient’s own body, particularly from the vertebrae that are removed during surgery. This approach supports better integration and healing.

Combined Approaches

For cases involving multiple levels of the spine, combined approaches are recommended. A supplemental posterior fusion and instrumentation can provide additional stability, ensuring long-term success.

By exploring these alternatives, surgeons can tailor spinal fusion procedures to meet the unique needs of each patient, optimizing outcomes and promoting faster recovery.

What additional procedures might surgeons employ if multiple levels are fused?

When multiple spinal levels are fused, surgeons can use additional procedures to ensure long-term stability and optimal healing. One common procedure is the insertion of a strut graft, which is a piece of bone, typically ranging from 1 to 2 inches. This graft helps fill the gap created during surgery, providing essential support to the anterior portion of the spinal column.

The graft can either be an allograft (bone from a donor) or an autograft (bone taken from the patient).  Either can play a crucial role in facilitating the fusion. To further stabilize the spine, anterior instrumentation, such as plates, screws, or rods, is often used in conjunction with the strut graft. This hardware helps keep the reconstructed area secure while it heals.

By combining these additional procedures, surgeons aim to promote a solid and durable spinal fusion, reducing the risk of future complications.

What is Internal Fixation and Why is it Necessary During a Cervical Corpectomy?

Internal fixation involves the use of medical hardware to stabilize bones. During a cervical corpectomy, this technique becomes essential for ensuring the proper alignment and fusion of vertebrae after a portion has been removed.

Why is Internal Fixation Necessary?

• Stability: To support the vertebrae and the bone graft, metal plates are often placed on the front of the cervical spine.
• Alignment: Screws are used to attach these plates to the remaining vertebrae and graft, maintaining correct spinal alignment.
• Healing: By immobilizing the spine, internal fixation allows the bone graft to fuse correctly with the remaining vertebrae, promoting effective healing and reducing the risk of complications.

In summary, internal fixation is a critical step in a cervical corpectomy to ensure stability, proper alignment, and successful healing of the vertebral column.

What is a Halo Jacket and When is it Used in Cervical Corpectomy Recovery?

A halo jacket is a specialized orthopedic device designed to stabilize the cervical spine, particularly after procedures like a cervical corpectomy. This apparatus features a metal ring (halo) that encircles the head, fixed in place with pins, and attached to a rigid jacket secured around the torso. The setup ensures the patient’s head remains perfectly still, promoting proper healing and spinal fusion.

When is it Used?

The use of a halo jacket is typically reserved for:

• Post-Surgical Recovery: Following surgeries like cervical corpectomy where vertebrae are removed; the device ensures spinal alignment as the bones fuse.
• Severe Cervical Spine Injuries: To prevent movement that could exacerbate damage.
• Uncommon Yet Critical Situations: Though not frequently needed, it becomes essential in cases demanding maximum immobilization for optimal recovery.

In essence, a halo jacket is a crucial tool in scenarios where absolute stability of the cervical spine is paramount.

Learn more about possible complications of spine surgery.

Potential Complications of a Cervical Corpectomy

Undergoing a cervical corpectomy involves careful consideration of potential risks. While the procedure can offer significant relief, it’s crucial to understand the possible complications that might arise.

Key Risks to Consider

• Infection: Post-surgical infections are a concern with any surgery. Treatments include antibiotics and, in severe cases, additional surgical intervention.
• Bleeding and Blood Clots: Excessive bleeding or the formation of blood clots can occur. Preventative measures like blood thinners may be used to mitigate this risk.
• Nerve Damage: Since the surgery involves proximity to the spinal cord, there’s a risk of nerve damage, which can lead to pain, numbness, or even paralysis.
• Spinal Instability: Removing a vertebra can potentially destabilize the spine. Fusion or other stabilizing techniques are often employed to address this issue.
• Persistent Pain: Some patients may continue to experience pain following the surgery, necessitating further medical management or physical therapy.

Additional Considerations

It’s essential to have a thorough discussion with your doctor about these and other potential complications before proceeding with a cervical corpectomy. Your doctor can provide a detailed evaluation of your specific condition and advise you on the associated risks and benefits.

For a more comprehensive understanding of the potential complications, review resources such as:

• External medical websites
• Detailed medical literature on spinal surgeries

This information is not exhaustive and should not substitute a detailed conversation with your healthcare provider. Only a qualified doctor can assess your situation and provide personalized guidance.

Rehabilitation

Doctors advise that neck operations require a neck brace because the operations are serious and complex.  Requiring a brace after surgery helps heal the procedure.  And some patients may need the extra support of a halo brace. On the other hand, most patients do not require rehabilitation after this surgery. However, if a patient experiences pain or difficulty doing routine activities, a short rehab under the direction of a physical therapist can certainly help

Finally, once the fusion becomes healed, the patient may progress toward a more vigorous rehabilitation program.

Learn more about spinal rehabilitation after surgery.

Recovery

The recovery time from a cervical corpectomy and strut graft can vary based on several factors, including the patient’s overall health, the extent of the surgery, and how well the patient follows post-operative care instructions. However, a general timeline for recovery is as follows:

Initial Recovery (First Few Weeks):

• Hospital Stay: Most patients stay in the hospital for 2-4 days after the surgery. During this time, they are monitored for any complications and begin their initial recovery.
• Pain Management: Doctors will manage Pain with medications, and patients may experience soreness and discomfort around the incision site and neck.
• Activity Restrictions: Patients are typically advised to avoid strenuous activities and heavy lifting. Patients may need to wear a neck brace to support the spine during the initial healing period.

Early Recovery (First 6-8 Weeks):

• Follow-Up Appointments: Regular follow-up appointments with the surgeon are necessary to monitor the healing process and ensure that the graft is fusing properly.
• Physical Therapy: Physical therapy may begin a few weeks after surgery to help improve strength, flexibility, and range of motion in the neck.
• Gradual Increase in Activity: Patients are usually encouraged to gradually increase their activity level, but they must avoid any activities that strain the neck.

Mid to Late Recovery (3-6 Months):

• Continued Physical Therapy: Physical therapy continues, focusing on more advanced exercises to restore normal function and strength.
• Return to Work: Depending on the nature of their job, some patients may return to light work within 4-6 weeks. Others with more physically demanding jobs might need up to 3 months or more before resuming full duties.

Full Recovery (6-12 Months):

• Bone Fusion: Complete fusion of the bone graft can take 6-12 months. During this time, patients need to follow their surgeon’s advice regarding activity restrictions and follow-up care.
• Long-Term Improvements: Many patients continue to experience improvements in pain and function throughout the first year after surgery.

Important Considerations:

• Individual Variability: Recovery times can vary significantly between individuals. Factors such as age, overall health, smoking status, and adherence to post-operative care play crucial roles in recovery.
• Complications: Potential complications, such as infection, non-fusion of the graft, or nerve damage, can extend the recovery period.
• Lifestyle Changes: Patients are encouraged to adopt a healthy lifestyle, including not smoking, maintaining a healthy weight, and following a nutritious diet, to support the healing process.

In conclusion, the initial recovery from a cervical corpectomy and strut graft can take a few weeks.  A full recovery and fusion of the bone graft typically take 6-12 months. Patients need to follow their surgeon’s guidance and attend all follow-up appointments to ensure the best possible outcome.

Why Choose The Southwest Scoliosis and Spine Institute

The following are just a few of the many reasons why patients might choose Southwest Scoliosis and Spine Institute.

• Expertise in the spine: The specialists at Southwest Scoliosis and Spine Institute comprise a talented team of spine experts.  They specialize in the diagnosis and treatment of spinal conditions, ensuring the best possible care for their patients.
• Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions.  In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
• Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery.  We ensure that patients receive complete, seamless care for their spinal conditions.
• Dedicated facilities: Southwest Scoliosis and Spine Institute is dedicated to providing patients with a safe and comfortable environment.

Finally, our board-certified physicians and fellowship-trained orthopedic surgeons use the full range of treatments to treat their spine patients. Southwest Scoliosis and Spine Institute’s experts with offices in Dallas, Plano, and Frisco, Texas offer cutting-edge technology, comprehensive care, and dedicated facilities to ensure the best possible care for their patients. Get in touch with us today to schedule an appointment.

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National Institute of Health: Cervical Corpectomy and Strut Graft