Cervical Corpectomy

Some cervical myelopathy is caused by compression of the spinal cord from the front that extends behind the body of a vertebra, rather than being confined to the disc spaces — for instance a large bone spur, a calcified ligament, or ossification of the posterior longitudinal ligament. In these situations, clearing the disc spaces alone may not fully relieve the cord. Removing the vertebral body itself provides the access needed to decompress the cord along its length and address the compressing structure directly.

Cervical corpectomy is carried out through the same natural plane at the front of the neck used for ACDF. The disc above and below the target vertebra are removed, and then the vertebral body itself is taken away, creating a channel that exposes and decompresses the spinal cord. The gap is reconstructed with a strut of bone graft or a cage to restore height and support the column, and a plate and screws are usually added for stability. Over the following months the reconstruction fuses into a solid segment. In some cases it is combined with additional fixation from behind.

Cervical corpectomy can be considered for cervical myelopathy where the cord is compressed from the front behind one or more vertebral bodies, such that removing discs alone would not fully decompress it. It is particularly relevant for retrovertebral spurs and ossification of the posterior longitudinal ligament. The alternatives — multilevel discectomy and fusion, a posterior approach, or a combined operation — are weighed according to where the compression lies, the number of levels, the alignment, and the individual. The decision is individualised.

The evidence compares corpectomy with other approaches for multilevel cord compression. Meta-analyses examining anterior cervical discectomy and fusion against corpectomy for multilevel myelopathy find that both can achieve good decompression and neurological improvement, with differences in fusion behaviour, blood loss and stability that guide the choice for a given pattern. Reviews of anterior versus posterior surgery for myelopathy inform when a corpectomy-based anterior approach is preferable. The balanced view is that cervical corpectomy is a well-established, effective option for front-of-cord compression that extends behind the vertebral body, chosen as part of an individualised plan.

The operation is performed under general anaesthetic, usually with a hospital stay of a few days, and recovery is broadly similar to other anterior cervical surgery, with a sore throat or mild swallowing discomfort common early on. The main aim is to relieve pressure on the cord; neurological recovery typically occurs gradually over months, and the reconstruction consolidates over a similar period. Rehabilitation supports recovery. As with any operation there are risks, which are discussed fully beforehand. The best approach for a given person is decided together.

• —Xiao SW, et al. Anterior cervical discectomy versus corpectomy for multilevel cervical spondylotic myelopathy: a meta-analysis. Eur Spine J 2015. (PMID 25326181)
• —Wang T, et al. ACDF versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy: systematic review and meta-analysis. Medicine (Baltimore) 2016. (PMID 25673996)
• —Sattari SA, et al. ACDF versus posterior decompression in degenerative cervical myelopathy: systematic review and meta-analysis. J Neurosurg Spine 2023. (PMID 36840737)