Corpectomy for Trauma

Not every spinal fracture needs surgery, and many stable injuries heal well with bracing and time. Corpectomy is reserved for the more severe injuries: fractures where a large fragment of crushed bone is compressing the spinal cord or nerve roots, where the vertebral body is too comminuted (shattered) to be reconstructed by other means, or where significant deformity and instability would not be corrected by a posterior operation alone. In these situations, removing the broken vertebral body allows the surgeon to decompress the neural structures directly from the front and to rebuild the column with a strong implant.

A corpectomy for trauma can be carried out through an anterior (front) approach, a posterior (back) approach, or a combined approach, depending on the level and pattern of injury. The damaged vertebral body and the adjacent discs are removed, relieving pressure on the spinal cord or nerves. The gap is then reconstructed — typically with an expandable cage or a strut graft that restores the height and load-bearing capacity of the column — and secured with instrumentation such as a plate or screws and rods. The result is a decompressed, realigned and stabilised spine that can heal in a good position.

The choice between anterior, posterior and combined approaches is individualised, and the evidence shows that each has strengths. Anterior corpectomy allows direct removal of bone compressing the cord from the front and excellent reconstruction of the vertebral body. Posterior approaches give powerful correction and fixation and are familiar to most surgeons. Combined approaches offer the most complete reconstruction for the most destructive injuries. Comparative studies and network meta-analyses of thoracolumbar burst fractures show broadly good outcomes across approaches, with the best choice depending on the fracture pattern, the neurology, and the patient's overall condition. This decision is made carefully for each individual.

The evidence supports corpectomy and reconstruction as an effective option for selected severe fractures. Network meta-analyses and systematic reviews comparing anterior, posterior and combined approaches for thoracolumbar burst fractures report good rates of neurological recovery and deformity correction, while highlighting that approach selection should be tailored to the injury. Studies of anterior corpectomy with cage or plate reconstruction show reliable restoration of alignment and stability, and the literature also flags issues such as cage subsidence and, in the cervical spine, early construct failure — which is why implant choice and technique matter and are planned meticulously.

Recovery depends on the severity of the original injury, whether there was neurological damage, and the extent of the reconstruction. The aim of surgery is to protect and, where possible, allow recovery of neurological function, to relieve pain from instability, and to give the spine a stable, well-aligned platform to heal on. Rehabilitation, often with physiotherapy, follows once the spine is protected, and the recovery plan is tailored to the individual operation. Where surgery is being considered, the risks, benefits and alternatives are discussed in detail so that decisions are made together.

• —Zhu Q, et al. Anterior, posterior and combined approaches for thoracolumbar burst fractures: a network meta-analysis. World Neurosurg 2024. (PMID 38199978)
• —Diaz JJ, et al. Surgical management of thoracolumbar burst fractures: anterior, posterior and combined — a network meta-analysis. World Neurosurg 2023. (PMID 37309497)
• —Xu GJ, et al. Anterior versus posterior approach for thoracolumbar burst fractures: a meta-analysis. Eur Spine J 2013. (PMID 24013718)
• —Hitchon PW, et al. Anterior corpectomy and plate fixation for acute thoracolumbar burst fractures. J Neurosurg 2004. (PMID 15534413)
• —Sasani M, et al. Anterior fusion and cage reconstruction for thoracolumbar burst fractures. J Spinal Disord Tech 2011. (PMID 21558966)
• —Daubs MD, et al. Early failures after cervical corpectomy reconstruction with mesh cages and anterior plating. Spine 2005. (PMID 15959369)