What is an anterior corpectomy?

What is Anterior Corpectomy?

Anterior corpectomy is a surgical procedure that involves the removal of one or more vertebral bodies along with the adjacent intervertebral discs through an anterior (front) approach to the spine, followed by reconstruction with a structural graft or cage and typically stabilization with anterior plate fixation. 1

Surgical Technique and Components

• The procedure consists of three major phases: corpectomy (removal of vertebral bodies), decompression of neural elements, and reconstruction with structural support. 2

• Corpectomy removes the entire vertebral body along with the adjacent discs above and below, providing extensive decompression of the spinal cord and nerve roots. 3

• Reconstruction is achieved using either structural bone grafts (autograft or allograft) or expandable cages to restore anterior column support and maintain spinal alignment. 4, 3

• Anterior plate fixation is typically added to enhance stability, reduce pseudarthrosis risk, and maintain cervical lordosis, particularly important for multilevel reconstructions. 1

Primary Indications

• Cervical spondylotic myelopathy with compression from vertebral body pathology (rather than isolated disc-level disease) is the primary indication for corpectomy. 1

• The procedure is recommended when 3 segments require decompression, as corpectomy provides better results than multilevel discectomy in this scenario. 1

• Vertebral body tumors requiring anterior column resection and reconstruction can be addressed through corpectomy, either via traditional anterior approach or posterior extracavitary technique. 4, 2

• Anteriorly located spinal cord compression from ossification or bony pathology behind the vertebral body that cannot be adequately addressed by discectomy alone. 5

Clinical Outcomes

• Corpectomy for cervical spondylotic myelopathy demonstrates a 3.3-point improvement on the Japanese Orthopaedic Association (JOA) scale, comparable to anterior segmental discectomy. 1

• For severe cervical myelopathy (JOA score <12), corpectomy improves scores from an average of 7.9 preoperatively to 13.3 at 1 year, 13.9 at 5 years, and 13.4 at 15-year follow-up. 1

• Long-term benefits are maintained for a minimum of 5 years and as long as 15 years postoperatively in patients with severe disease. 1

Comparison to Alternative Procedures

• Corpectomy provides a larger surface area for fusion compared to multilevel anterior cervical discectomy and fusion (ACDF), which may improve fusion rates when anterior plating is not used. 1

• Without anterior fixation, corpectomy provides higher fusion rates than multilevel ACDF but also carries a higher graft failure rate. 1

• When anterior plate fixation is used, corpectomy and multilevel ACDF yield similar fusion rates and clinical outcomes for multilevel disease. 1

• Corpectomy is functionally equivalent to multilevel ACDF when contained to 1 vertebral body level, but becomes technically more challenging and has higher complication rates. 3

Common Complications and Pitfalls

• Pseudarthrosis (nonunion) occurs in approximately 10.9% of cases, leading to persistent pain, neurological symptoms, and potential hardware failure. 6

• Graft or cage subsidence can occur from insufficient anterior column support, excessive motion at operated segments, or inadequate plate fixation. 6

• Recurrent laryngeal nerve palsy is a recognized complication, with permanent injury occurring in some cases. 7

• The procedure is technically more difficult than traditional ACDF and carries a higher overall complication rate, requiring careful patient selection and surgical expertise. 3

Reconstruction Options

• Expandable cages allow for collapsed insertion and in situ expansion, which is particularly useful for lumbar reconstructions without sacrificing nerve roots. 4

• Autogenous bone graft remains the gold standard for achieving solid arthrodesis, though structural allografts and cages are commonly used alternatives. 8

• Anterior revision with plate stabilization achieves 83.3% good/excellent outcomes when treating pseudarthrosis after corpectomy. 6

• Posterior approach revision demonstrates a 94% fusion rate compared to 45% with anterior revision when managing hardware failure. 6

Special Considerations

• Endoscopic partial corpectomy preserves most of the vertebral body and disc, maintaining spinal stability without fusion, though long-term data in large patient populations is lacking. 5

• Corpectomy can be performed through alternative approaches including transoral resection for upper cervical lesions or posterior extracavitary approach for thoracolumbar tumors. 4, 2

• Lower cervical and upper thoracic corpectomy (C7-T4) can be performed through a low cervical approach without sternotomy, sparing patients the morbidity of more extensive exposures. 7