A cervical corpectomy is a surgical procedure performed to remove one or more vertebrae (bones) in the cervical spine (neck). A corpectomy involves removing the front part of the vertebra, the vertebral body. The portion of bone that surrounds and protects the spinal cord is preserved. Bone graft is inserted into the open space and stimulates new bone growth, eventually joining the upper and lower vertebrae together. This is called fusion.

A cervical corpectomy is performed to decompress the nerve roots and/or spinal cord. To decompress (decompression) means to remove something that is compressing (exerting pressure on) a nerve root or the spinal cord. In extreme cases of cervical spinal stenosis, a condition in which bone thickens and produces bone spurs, or osteophytes, neck pain and other symptoms that may spread down the neck and into the shoulder, arm, and hand.

In most cases when surgery is warranted, an ACDF (anterior cervical discectomy with fusion) is done, in which only the disc is removed along with enough bone to decompress the nerves. Significant and advanced spinal cord problems must be present for a corpectomy to be considered, including severe pain, extreme weakness, numbness and loss of function of the fine motor skills of the hand.

Cervical corpectomy may also be performed during spinal tumor removal or significant trauma.

What to Know Before Your Cervical Corpectomy

You must stop tobacco use before surgery. Nicotine hinders bone growth, slows healing, increases the risk of infection, and increases your risk of a failed fusion.

Tell your doctor about all prescription and over-the-counter medications you take. In your list, include vitamins, herbal products and other supplements. Some drugs and supplements, such as blood thinners and anti-inflammatory medications, must be discontinued before surgery. Your doctor will provide you with written instructions to avoid any confusion.

Your spine surgeon will provide other written instructions. These include not eating or drinking after midnight the night before your surgery and making arrangements to have someone drive you home after hospitalization.

Potential Risks or Complications Include:

All medical procedures, nonoperative or surgical, have some risk of complications. Risks associated with this surgery are greater than with other cervical spine surgery procedures. Risks are particularly associated with neurologic issues, bone grafting, bleeding and stroke. Carefully discuss your decision to have surgery, including risks and benefits, with your spine surgeon. The final decision is yours.

• You may experience hoarseness and/or difficulty swallowing. The recurrent laryngeal nerve, which innervates the vocal cords, is moved during surgery. Usually, these problems are resolved within a few weeks or months. Rarely is treatment by an ear, nose and throat specialist needed.
• Your vertebrae may fail to fuse. This is called nonunion or failed fusion and may require additional surgery.
• Implants may break or dislodge, potentially requiring additional surgery. The term implants refers to instrumentation and devices.
• Bone graft may migrate or dislodge, resulting in nonunion and potentially requiring additional surgery.
• Spine surgery may not resolve symptoms such as pain, tingling, numbness, or weakness. In some cases, the nerves are permanently damaged by herniated disc material or bone spurs, and decompression surgery does not relieve the symptoms. The longer a nerve has been irritated, the longer it may take to heal.
• Damage to the spinal cord can lead to partial or complete paralysis. Corpectomy surgery is only performed when significant spinal cord damage symptoms are already present, which can place the cord and nerves at greater risk during and after surgery.
• There is a slight risk that, while removing the vertebral body, the vertebral artery that runs on the side of the spine may be injured, which can lead to stroke and/or life-threatening bleeding.
• Complications from cervical corpectomy may require additional treatment, including medication or surgery.
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Surgery Day

Wear loose-fitting clothing and flat-heeled, slip-on shoes with closed backs to the hospital. Consider wearing a front buttoning shirt to easily dress after your discharge home.

If instructed, take medication on the morning of surgery with small sips of water.

At the Hospital

• The medical staff reviews your history, condition, medications, allergies and other pertinent information with you.
• You are given a gown to change into and instructed to remove personal articles such as jewelry and dentures. Your clothing and personal effects are safely secured.
• The nurse attaches monitors to you to track your heart rate, blood pressure, pulse, and oxygen levels.
• The anesthesiologist meets with you to discuss your care and to answer questions.
• An intravenous (IV) line is inserted into your arm or hand. Medications to help you relax and prevent pain, nausea and infection (antibiotics) are administered through the IV.

About the Cervical Corpectomy Procedure and Recovery Room

• You are positioned on your back on the operating table. Medication administered through your IV causes you to fall asleep. When you are asleep, the anesthesiologist inserts a tube through your mouth and into your throat to keep your airway open during surgery. The procedure is performed using general anesthesia.
• Your head is positioned, and the neck area prepped. If your surgeon plans to use your own bone (autograft) for the bone graft, your hip area (iliac crest) will also be prepared. Obtaining the bone graft from your hip is also a surgical procedure.
• To help manage the risk of spinal cord injury, a diagnostic tool called SSEP (somatosensory evoked potentials) may be used. SSEP monitors and measures communication and response between the brain, spinal cord, and nerves.
• An incision about three inches long is made at the side of your neck. The spine surgeon carefully moves aside the neck muscles, trachea (windpipe), esophagus (membrane/tube to the stomach), and arteries. Retractors hold these anatomical structures in place. The layer of muscle over the front of your spine is moved aside to allow the surgeon to see the bony vertebrae and discs.
• Using image guidance (such as fluoroscopy or real-time X-ray), the surgeon passes a thin needle into the discs to confirm the operative level.
• The discs above and below the vertebral body are removed (discectomy) using small grasping and cutting instruments.
• A small rotary cutting tool is used to separate the vertebral body from the posterior (rear) part of the vertebra.
• The ligament that runs behind the vertebral body may be shaved to remove any thickened or hardened areas or entirely removed.
• The endplates, which connect the disc to the vertebral body, are roughened using a drill or other tool and made to bleed. This encourages the fusion process.
• If bone is to be taken from your hip (autograft), an incision is made at the top of your hip bone (about where you place your hands on your hips), and a wedge of the bone's inner layer is removed. These wedges are inserted between the vertebral bodies. Alternatively, your spine surgeon may use donated bone (allograft) or a bone graft substitute. Bone graft substitutes are made from ceramic, plastic or bioresorbable compounds.
• A metal plate is placed over the grafted area and held in place by screws affixed to the vertebral bodies.
• If additional spinal stability is needed, the posterior (back) spine may be fused too. Instrumentation holds the fusion in place.
• An X-ray or fluoroscopy is performed to ensure the graft and instrumentation are in place.
• The retractors are removed, the muscle and other structures are allowed to move back into place, and the muscle and skin are closed with sutures and dressed with a bandage over the wound.
• You may be placed in a neck or halo brace while healing and fusion occur.
• You wake up in the recovery room. Some patients report immediate pain relief upon waking up. You may be given some ice chips to eat.
• You are moved to your hospital room for the remainder of your stay.

Discharge and Recovery After Cervical Corpectomy

You are released from the hospital when your condition is stable. You are sent home with a prescription for pain medication. Some medications (narcotics for pain) are addictive and should be used for fewer than two weeks. Many patients find they no longer need pain medication after only a few days. Pain is then managed with acetaminophen (Tylenol).

At-Home Instructions may Include:

• Resume regular medications as directed by your spine surgeon.
• Do not take nonsteroidal anti-inflammatory drugs (NSAIDs such as aspirin, ibuprofen, Motrin, Aleve and Advil) until your spine surgeon agrees. These drugs can cause bleeding and inhibit fusion.
• Short-term application of an ice pack can help reduce pain or tenderness. Do not apply heat.
• If bone graft was taken from your hip, you may experience pain or soreness in that area. Use an ice pack for short intervals and take frequent breaks to walk around or change position.
• Leave any bandage in place as directed by your surgeon.
• You may shower as directed.
• You may experience hoarseness, sore throat or difficulty swallowing. This is normal and should resolve in one to four weeks.
• Do not smoke or use tobacco products. Nicotine delays healing and increases your risk for fusion problems (nonunion).
• Drink extra fluids and increase your dietary fiber to manage constipation; this is normal for a few days after surgery.
• Do not drive until cleared to do so by your spine surgeon.

Call Your Spine Surgeon If:

• Your temperature exceeds 101 degrees F.
• The incision begins to separate or shows signs of infection. Signs of infection include redness, swelling, pain, and/or drainage (light blood or clear fluid is normal).
• Swallowing problems interfere with breathing or the ability to drink water.
• You experience numbness, weakness or loss of function.

General guidelines for the first two weeks after surgery

• Avoid sitting for long periods
• Avoid extreme bending of your neck
• Do not lift anything heavier than five pounds or as instructed by your surgeon.
• Do not do household chores without your surgeon's clearance. This includes activities such as vacuuming, ironing, dishwashing, laundry and gardening or yard work.
• Do not take a tub bath or get into a hot tub or swimming pool until cleared by your spine surgeon.

Your Spine Surgeon Will Recommend When You Are Ready To:

• Gradually return to normal activity
• Begin a walking regimen
• Have sutures or staples removed if necessary, as instructed by your spine surgeon
• Begin a rehabilitation or physical therapy program if appropriate

Some patients experience a tingling or warm feeling in the arm on the side where surgery was performed. While this may be present as the nerves heal, please contact your spine surgeon if symptoms worsen.

Follow-up With Your Spine Surgeon

Remember to keep all of your postoperative appointments and never hesitate to call your spine surgeon's office if you have questions or concerns.