cervical_oblique_corpectomy

Cervical oblique corpectomy

The technique of oblique corpectomy has been reported for the first time in 1993 to access lesions developed in the anterior part of the spinal canal 1).

Since 1992, the technique of multilevel oblique corpectomy (MOC) has been applied at Lariboisière Hospital for the surgical treatment of spondylotic myeloradiculopathy and a first series has been published in 1999 2).

From this time, several teams have confirmed favorable outcome 3) 4) 5) 6) , through retrospective but also prospective works 7) , and indications have been enlarged to ossification of the posterior longitudinal ligament 8) 9).

Multilevel cervical oblique corpectomy and/or lateral foraminotomy allow wide decompression of nervous structures, while maintaining optimal stability and physiological motion of the cervical spine 10).

The lateral foraminotomy and the oblique corpectomy technique, by preserving over 50% of the vertebral body and preserving two of the three columns, do not compromise spinal stability so that bone grafts or instrumental arthrodesis are not necessary 11).

Techniques using lateral multiple oblique corpectomy (MOC) and/or foraminotomy 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) have been used with increasing frequency. In general, when three or more levels are affected, the preferred techniques remain either an anterior multilevel corpectomy or a posterior route such as laminectomy, open door laminoplasty, and posterior foraminotomy. However, the best management of such pathology (especially if 3 or more levels are involved) remains controversial.

Case series

Kunert et al., describe four patients with cervical spinal epidural abscesses SEAs that were evacuated by cervical oblique corpectomy (OC) without fusion.

This study included two women and two men (aged 44-90) that received operations for removing ventral cervical SEAs. All patients presented with progressively increasing myelopathy, and 3 had severe comorbid conditions. In all cases, a multilevel OC without fusion was performed. The amount of bone resection was tailored to fit the needs of granulation removal, with an effort to retain as much of the vertebral bodies as possible. Then, pus was evacuated and debridement of granulation was performed, followed by rinsing and drainage.

The neurological status of 3 patients improved significantly after surgery. At the last follow-up examination, one showed full recovery, and in two a minor residual deficit persisted. During mean follow-up of 5.5 years, no internal stabilization was necessary. The oldest patient was tetraplegic, and had several concomitant diseases. That patient died from sudden cardiac arrest on the third postoperative day. Oblique corpectomy did not affect the anterior or posterior column. Additionally, it provided a broad view of the ventral aspect of the spinal canal.

Oblique corpectomy allows appropriate spinal cord decompression and granulation removal in the case of cervical spine epidural abscess, without sacrificing spinal stability 22).

Video

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1)
George B, Zerah M, Lot G, et al. (1993) Oblique transcorporeal approach to anteriorly located lesions in the cervical spinal canal. Acta Neurochir (Wien) 121:187–90.
2)
George B, Gauthier N, Lot G (1999) Multisegmental cervical spondylotic myelopathy and radiculopathy treated by multilevel oblique corpectomies without fusion. Neurosurgery 44:81–90.
3)
Koc RK, Menku A, Akdemir H, et al. (2004) Cervical spondylotic myelopathy and radiculopathy treated by oblique corpectomies without fusion. Neurosurg Rev 27:252–8.
4) , 8)
Goel A, Pareikh S (2005) Limited oblique corpectomy for treatment of ossified posterior longitudinal ligament. Neurol India 53:280–2.
5) , 7)
Kiris T, Kilincer C (2008) Cervical spondylotic myelopathy treated by oblique corpectomy: a prospective study. Neurosurgery 62:674–82 [discussion 682].
6)
Rocchi G, Caroli E, Salvati M, et al. (2005) Multilevel oblique corpectomy without fusion: our experience in 48 patients. Spine 30:1963–9.
9)
Chacko AG, Daniel RT (2007) Multilevel cervical oblique corpectomy in the treatment of ossified posterior longitudinal ligament in the presence of ossified anterior longitudinal ligament. Spine 32:E575–80.
10)
Salvatore C, Orphee M, Damien B, Alisha R, Pavel P, Bernard G. Oblique corpectomy to manage cervical myeloradiculopathy. Neurol Res Int. 2011;2011:734232. doi: 10.1155/2011/734232. Epub 2011 Oct 19. PubMed PMID: 22028964; PubMed Central PMCID: PMC3199080.
11) , 15)
Chibbaro S, Mirone G, Bresson D, George B. Cervical spine lateral approach for myeloradiculopathy: technique and pitfalls. Surgical Neurology. 2009;72(4):318–324.
12)
Bruneau M, Cornelius JF, George B. Multilevel oblique corpectomies: surgical indications and technique. Neurosurgery. 2007;61(3, supplement):S106–S112.
13)
Bruneau M, Cornelius JF, George B. Microsurgical cervical nerve root decompression by anterolateral approach. Neurosurgery. 2006;58(1, supplement):S108–S113.
14)
Çagli S, Chamberlain RH, Sonntag VKH, Crawford NR. The biomechanical effects of cervical multilevel oblique corpectomy. Spine. 2004;29(13):1420–1427.
16)
George B, Blanquet A, Alves O. Surgical exposure of the vertebral artery. Operative Techniques in Neurosurgery. 2001;4(4):182–194.
17)
George B, Cornelius J. Vertebral artery: surgical anatomy. Operative Techniques in Neurosurgery. 2001;4(4):168–181.
18)
George B, Gauthier N, Lot G. Multisegmental cervical spondylotic myelopathy and radiculopathy treated by multilevel oblique corpectomies without fusion. Neurosurgery. 1999;44(1):81–90.
19)
George B, Lot G. Oblique transcorporeal drilling to treat anterior compression of the spinal cord at the cervical level. Minimally Invasive Neurosurgery. 1994;37(2):48–52.
20)
George B, Zerah M, Lot G, Hurth M. Oblique transcorporeal approach to anteriorly located lesions in the cervical spinal canal. Acta Neurochirurgica. 1993;121(3-4):187–190.
21)
Rocchi G, Caroli E, Salvati M, Delfini R. Multilevel oblique corpectomy without fusion: our experience in 48 patients. Spine. 2005;30(17):1963–1969.
22)
Kunert P, Prokopienko M, Nowak A, Czernicki T, Marchel A. Oblique corpectomy for treatment of cervical spine epidural abscesses: Report on four cases. Neurol Neurochir Pol. 2016 Aug 24. pii: S0028-3843(16)30094-9. doi: 10.1016/j.pjnns.2016.08.001. [Epub ahead of print] PubMed PMID: 27576671.
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