Multilevel oblique corpectomies: surgical indications and technique

Abstract

Objective: We describe extensively the multilevel oblique corpectomy technique with its advantages, disadvantages, indications, and biomechanical effects. This procedure is an alternative to the anterior corpectomy.

Methods: Multilevel oblique corpectomy can be indicated in spondylotic myelopathy, whether or not it is associated with unilateral radiculopathy. Certain conditions must be fulfilled: anterior compression must be predominant, the spine must be kyphotic or straight, preoperative instability has to be excluded, and intervertebral discs have to be dehydrated and collapsed.

Results: The lateral aspect of the cervical spine is reached and the vertebral artery is controlled through a lateral approach. The lateral part of the pathological intervertebral discs is removed. Then, the lateral portion of the vertebral body is drilled to create an 8-mm wide vertical trench. When the posterior cortical bone as well as the superior and inferior end plates are reached, the microscope is moved obliquely to extend the drilling horizontally as long as required, up to the contralateral pedicle if necessary. Next, the posterior cortical bone and the posterior longitudinal ligament are removed to completely decompress the spinal cord. In the case of radiculopathy, the ipsilateral foramen can be completely opened by taking away the uncovertebral joint after its lateral aspect has been separated from the vertebral artery.

Conclusion: The multilevel oblique corpectomy technique allows wide anterior decompression of the spinal cord and complete unilateral nerve root decompression. Using this technique, the spinal stability is preserved and osteoarthrodesis is not required. Spinal motions are preserved and appear close to normal.