Introduction

A corpectomy is a surgical procedure to relieve pressure on the spinal cord due to spinal stenosis. In spinal stenosis, bone spurs press against the spinal cord, leading to a condition called myelopathy. This can produce problems with the bowels and bladder and disrupt the way you walk. Fine motor skills of the hand may also be impaired. In a corpectomy, the front part of the spinal column is removed. Bone grafts are used to fill in the space. This procedure is used when bone spurs have developed in more than one vertebra. 

Surgical Procedure

A general anesthesia is often used to put you to sleep. As you sleep, your breathing may be assisted with a ventilator.

Doctors perform this surgery through the front of the neck, the anterior neck region. The surgeon starts by making an incision up the left side of the neck to the ear and then under the jaw to the bottom of the chin. The skin flap is opened to expose the structures of the neck. Retractors are used to separate and hold the muscles and soft tissues apart so the doctor can work on the front of the spine.

Special instruments are attached either to the skull or the spinal bones to stretch the neck with mild traction. The traction pull spreads the neck joints apart to give the doctor more room to work. It also takes additional pressure off the spinal cord. Then the doctor inserts a needle into the disc and does an X-ray to locate the exact sections where the bones are to be removed. 

The doctor carefully cuts part of the anterior longitudinal ligament away from the front section of the spinal column.  

Instruments are then used to take out the front half of the discs that lie between the vertebral bodies.

Next, a small rotary cutting tool (a burr) is used to carefully remove the back half of the discs (called discectomy) and a row of vertebral bodies (called corpectomy). 

The ring of bone that surrounds and protects the spinal column isn't touched.

When the discs and vertebral bodies are out of the way, the posterior longitudinal ligament can be seen where it covers the front of the spinal cord. This thin ligament is shaved to remove areas that have hardened or buckled, as these areas are known to add pressure to the spinal cord.

The doctor then prepares a bone graft that will fill in the space where the discs and vertebral bodies have been removed. A section of bone graft is taken from the fibula bone, the thin bone that runs along the outside of the lower leg. (This is not the main bone of the shin, called the tibia.) Some doctors prefer to take bone from the pelvis instead of the fibula.

Before inserting the bone graft, the doctor increases the traction pull on the neck to help separate the space even more. The bone graft is sized to fill the full length of the removed section of bone and discs from one end to the other.

The section of bone is grafted into the space where the vertebral bones have been taken out. The graft acts like a supportive column, or strut, to support the elongated space and to prevent the neck from buckling forward. Your doctor may attach a metal plate along the front of the spine to help lock the new graft in place.

Another X-ray is taken to check the position of the graft. Then the muscles and soft tissues are put back in place, and the skin is stitched together. Patients are often placed in a rigid neck brace for at least three months to hold the neck still while the bones grow together, or fuse.

Rehabilitation

Rehabilitation after corpectomy surgery can be a slow process. You will probably need to attend therapy sessions for two to three months, and you should expect full recovery to take up to one year.

Many doctors prescribe outpatient physical therapy beginning a minimum of five weeks after surgery. At first, treatments are used to help control pain and inflammation. Ice and electrical stimulation treatments are commonly used to help with these goals. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain.

Active treatments are slowly added. These include exercises for improving heart and lung function. Walking, stationary cycling, and arm cycling are ideal cardiovascular exercises. Therapists also teach specific exercises to help tone and control the muscles that stabilize the neck and upper back. 

Your therapist also works with you on how to move and do activities. This form of treatment, called body mechanics, is used to help you develop new movement habits. This training helps you keep your neck in safe positions as you go about your work and daily activities. At first, this may be as simple as helping you learn how to move safely and easily in and out of bed, how to get dressed and undressed, and how to do some of your routine activities. Then you'll learn how to keep your neck safe while you lift and carry items and as you begin to do other heavier activities.

As your condition improves, your therapist will tailor your program to help prepare you to go back to work. Some patients are not able to go back to a previous job that requires heavy and strenuous tasks. Your therapist may suggest changes in job tasks that enable you to go back to your previous job. You'll learn new ways to do these tasks to keep your neck safe and free of extra strain.

Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.