Corpectomy is an extremely invasive surgical technique that removes one or more vertebral bodies in order to decompress the spinal cord, subsequently replacing the missing bone with a graft, implant and/or other hardware-assisted fixation. Vertebral removal surgery is the most damaging form of common spinal operation performed and truly changes the amazing natural design and functionality of the backbone to a largely negative degree.
Vertebral removal surgery is used for many reasons in the modern back and neck pain treatment arena. The drastic procedure was originally used in the very worst cases of spinal trauma that often resulted in complete vertebral column instability, as well as for the most pathological forms of central spinal stenosis.
We now see vertebral body elimination surgery used routinely for conditions that might not even require any surgical intervention at all. In fact, the applications for this procedure now include mild to moderate central canal stenosis, disc calcification (osteochondral bars), and a wide range of other spinal abnormalities including atypical curvature issues and irregular vertebral misalignments.
This critical dialog examines vertebral removal surgery. We will detail the procedures used and the variations of technique that are possible. However, we will also explore why this barbaric operation is most often a terrible option for any patient with typical back or neck pain circumstances.
Vertebral removal operations all seek to accomplish a primary surgical goal. In most cases, this objective is to decompress the central spinal canal, eliminating pressure from the spinal cord and nerve roots. In other cases, the primary surgical goal might be to restore stability to the spine due to traumatic injury that has left one or more vertebral bones irreparably damaged.
Vertebral removal procedures can target the neck, upper back, middle back or lower back. The most common regions treated are certainly the 2 areas that suffer them most noticeable spinal deterioration: the mid to lower cervical spine and the lower lumbar spine.
During a vertebral removal operation, one or more of the vertebral bodies are eliminated and the intervertebral discs that reside above and below the operated spinal level(s) are also excised. The goal is to remove tissues that are preventing normal spinal nerve function, or are compromising the structural integrity of the entire backbone, replacing these tissues with organic or synthetic bone grafts or synthetic hardware.
Vertebral Removal Procedure
Corpectomy techniques can be accomplished traditionally, using a single large dorsal incision, or can be completed using more modern minimally invasive techniques that involve one or more smaller incisions in the flank or anterior surface of the body.
In all cases, the surgeon will enter the body and use a variety of surgical tools to access the interior of the spine, cutting away the unwanted vertebral body in the process. This will leave a hole in the spine, since one or more bones will be excised. Surrounding intervertebral tissues will also be removed to allow bone graft and/or hardware fixation to the vertebrae that neighbor the empty space above and below the operated level(s).
Once the skeletal pieces have been removed, the surgeon will have to repair the created defect using one of several possible procedures:
Spinal fusion is the most common path to restoring the empty space created by the vertebral removal operation. In fusion scenarios, the patient will receive a bone graft that may be harvested from their own body, harvested from a cadaver or created using synthetic materials to simulate actual bone. Once the graft is put in place, fixation hardware is almost always employed to bond the vertebral bones above and below the defect together, in order to facilitate healing of the fusion during the very long and often arduous recuperation period. This metallic hardware might be left in place permanently or may eventually be removed once the fusion has fully healed.
The surgeon may elect to utilize a cage fixation apparatus, most often in combination with a bone graft. This technique is similar to the above bone-oriented fusion, except a metallic cage is positioned in the missing vertebral space to maintain the relative vertebral positioning and provide extra support for bone fragments that are placed within the cage to create the fusion of bone-to-bone contact. In these cases, the graft grows through and around the cage, adding strength to the fusion, but also creating additional room for hardware-related complications to occur.
The last procedural option utilizes a spacer implant to take the place of a bone graft, or work in combination with a bone graft, to restore the stability of the spine after vertebral removal. These fascinating techniques are detailed in the section below.
Corpectomy Implants and Hardware
Implant-based spinal restoration following corpectomy is becoming far more commonplace. There are many different medical devices that have been designed and built for this specific purpose and virtually all of these devices claim superior results when compared to traditional bone-graft fusion techniques for operative defect restoration.
Some of the most often utilized of these vertebral substitutes include the Synex System, manufactured by Synthes Spine, as well as the Fortify and Xpand devices, both manufactured by Globus Medical.
All of these implant devices are synthetic and basically act as a spacer in between the remaining organic vertebral bones that surround the defect created by the removal procedure. The devices are most often permanently and securely attached to the bones above and below, restoring stability of the backbone and preventing the spine from collapsing upon itself.
Hardware fixation is used for virtually all types of vertebral removal restoration, including natural, synthetic and implant-assisted fusions. The types of hardware utilized varies greatly and might include a diversity of plates, bars, screws and rods that help to hold the spine together during healing or forever.
Vertebral removal surgery is incredibly difficult to endure and involves a long and painful recovery process for most patients. When everything goes perfectly, the technique can be a lifesaver, but unfortunately, things rarely work out ideally.
Complication rate for corpectomy operations is even greater than for normal spinal fusions. This is frightening, since a significant number of fusion patients suffer serious and often enduring complications.
Most postoperative patients are deemed surgical successes. This means that the spine is stable, has healed and is indeed functional from a basic mechanical viewpoint. However, a large percentage of patients have severe postoperative symptoms, including pain, physical restrictions, neurological symptoms like numbness, tingling or weakness and these symptoms are often far worse after the surgery than before.
Complications that can create a failed surgery are also relatively common immediately or eventually. These poor outcomes may be the results of fusions that never solidified, nerve damage, hardware-related problems or the inherent increased degeneration on the surrounding vertebral and intervertebral levels that is known to be the most universally problematic issue with all manner of fusion techniques.
It is for this reason that we generally advise most patients to avoid fusions and vertebral removal surgeries if at all possible. There are usually other options and in no case should either of these procedures be used unless it becomes a matter of life or death and the diagnosed condition is truly indicated for treatment.
To summarize, corpectomy changes the natural design of the spine and causes a range of functional issues that can prevent normal life far into the future. When circumstances provide no other option for a patient, they might have to acquiesce to the risks and take their chances, hoping for a positive outcome. Some patients will enjoy satisfying results and feel much better after the surgery than before. Others will not fare so well, but have little choice but to try. However, if any other possible path of treatment exists, we suggest exploring it and saving vertebral removal and fusion as a truly final option once all other paths have been exhausted.