Oblique Corpectomy Research Articles

Optimal anatomical angle and distance for drilling in cervical oblique corpectomy: A surgical anatomical study.

One of the difficulties of oblique corpectomy, less discussed in the literature, is the problem of how to achieve an optimum corpectomy. Therefore, this anatomico-radiological study was conducted to shed light on the use of the microscope at an appropriate angle and optimum drill distances in clinical cases undergoing cervical oblique corpectomy surgery. We examined the average distance of the diagonal line extending from the medial aspect of the ipsilateral vertebral foramen to the contralateral pedicle in cervical computed tomography -angiography axial scans in four cervical vertebrae, C3, C4, C5, and C6. We also measured the average angle between this diagonal trajectory and the horizontal line, making a total of 712 measurements in 89 patients. We found that horizontal drilling with an average length of 23-26 mm at an acute angle of about 22° -23° is optimal for adequate decompression of the spinal cord in the oblique corpectomy approach. Depending on the patient and the level of the vertebra, the distance and the angle of the horizontal drilling may range from 18 mm to 31 mm and from 15° to 33°, respectively. For an optimum cervical oblique corpectomy that provides adequate spinal cord decompression and maintains spinal stability, it is necessary to operate under a surgical microscope positioned at an acute angle and to know the horizontal drilling distance.

Surgical management of Diffuse Idiopathic Skeletal Hyperostosis (DISH) causing secondary dysphagia (Narrative review)

Objectives: To summarize the current evidence on surgical treatment for large bridging osteophytes of the anterior cervical spine from Diffuse Idiopathic Skeletal Hyperostosis (DISH). Overview of Literature: In the current review, the surgical treatment of secondary dysphagia from DISH was the most useful treatment. We propose a treatment algorithm for management of this condition because currently there are only case reports and retrospective studies available. Methods: Literature search was performed using the MeSH terms "Anterior Cervical Osteophyte," "Diffuse Idiopathic Skeletal Hyperostosis (DISH)," and "Dysphagia" and "Treatment" for articles published between January 2000 and February 2020. PubMed search identified 117 articles that met the initial screening criteria. Detailed analysis identified the 40 best matching articles, following which the full inclusion and exclusion criteria left 11 articles for this review. Results: Incidence of secondary dysphagia was associated with DISH in elderly patients (average 65years). The major clinical findings were dysphagia or respiratory compromise, with the most common level of bridging osteophytes of the cervical spine at C3-C5. There were 10 articles on surgical treatment involving anterior cervical osteophytectomy without fusion, 1 for multilevel cervical oblique corpectomy, 1 for anterior cervical discectomy with fusion plus plate, and 1 for anterior cervical osteophytectomy with stand-alone PEEK cage or plus plate. All the cases resulted in significant improvement without recurrence, with only 1 case having post-operative complications. Follow-up duration was 3-70.3months. Conclusions: Surgical intervention for anterior cervical osteophytectomy appears to result in improved outcomes. However, there could be disadvantages concerning cervical spine motion if cervical osteophytectomy with cervical discectomy and fusion (ACDF) plus plate system is done.

Cervical Oblique Corpectomy: Revitalizing the Underused Surgical Approach With Step-By-Step Simulation in Cadavers.

Recently, the World Federation of Neurosurgical Societies Spine committee recommended that additional research on cost-benefit analysis of various surgical approaches for cervical spondylotic myelopathy be carried out and their efficacy with long-term outcomes be compared. Unfortunately, it is highly probable that the oblique corpectomy (OC) will not be included in cost-benefit investigations due to its infrequent application by neurosurgeons dealing with the spine. In this cadaveric study, head and necks of 5 adult human cadavers stained with colored latex and preserved in 70% alcohol solution were dissected under a table-mounted surgical microscope using 3× to 40× magnifications. The OC approach was performed to simulate real surgery, and the neurovascular structures encountered during the procedure and their relations with each other were examined. Oblique corpectomy was performed unilaterally, although neck dissections were performed bilaterally on 10 sides in all 5 cadavers. At each stage of the dissection, multiple three-dimensional photographs were obtained from different angles and distances. For an optimal OC, both the anterior spinal cord must be sufficiently decompressed and sufficient bone must be left in place to prevent instability in the cervical spine. Oblique corpectomy is a valid and potentially low cost alternative to other anterior and posterior approaches in the surgical treatment of cervical spondylotic myelopathy. However, meticulous cadaver studies are essential before starting real surgical practice on patients in order to perform it effectively and to avoid the risks of the technique.

Cervical Spondylotic Myelopathy with Ossification of Posterior Longitudinal Ligament: Which Is the Most Suitable Surgical Procedure? A Technical Note.

Introduction Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are widely performed to resolve anterior cervical spine compression. The main purpose of the different surgical techniques is to obtain an adequate decompression of the spinal cord and nerve roots, preserving spinal stability like in oblique corpectomy or leading to a final solid construct to achieve arthrodesis. Technical Note We describe a surgical procedure for treating cervical spondylotic myelopathy(CSM) with ossification of the posterior longitudinal ligament (OPLL) at the level of C3-C4 and C4-C5. A double level discectomy C3-C4 and C4-C5 and selective posterior wedge corpectomy of C3, C4, and C5 were performed. Two cages (Zero-P VA) at C3-C4 and C4-C5 were positioned to obtain segmental stability and arthrodesis. An extended anterior cervical canal decompression was obtained and confirmed by postsurgical CT scan. At 15 months, dynamic X-ray showed fusion, and cervical magnetic resonance imaging (MRI) showed evidence of spinal canal decompression. Conclusions Anterior cervical discectomy followed by selective wedge corpectomy appears to be a safe and effective technique for anterior spinal cord compression extending above and below the intervertebral disc space.

Anterior Surgical Techniques for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations.

ObjectiveThis study was performed to review the literature and to present the most up-to-date information and recommendations on the indications, complications, and success rate of anterior surgical techniques for cervical spondylotic myelopathy (CSM). The commonly performed anterior surgical procedures are multiple-level anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion and its variants (skip corpectomy and hybrid surgery), and oblique corpectomy without fusion. MethodsA comprehensive literature search and analysis were performed using MEDLINE (PubMed), the Cochrane Register of Controlled Trials, and the Web of Science for peer-reviewed articles published in English during the last 10 years. ResultsCorpectomy is mandated for ventral compression of fewer than 3 vertebral segments where single-level disc and osteophyte excision is inadequate to decompress the cord. Endoscopic or oblique partial corpectomy improves the sagittal canal diameter by 67% and obviates the need for an additional bone graft procedure. ConclusionThe indications of anterior surgery in patients with CSM include a straightened or kyphotic spine with a compression level lower than 3. With an appropriate choice of implants and meticulous surgical technique, surgical complications can be seen only rarely. Improvements after anterior surgery for CSM have been reported in 70% to 80% of patients.

Surgical technique for the protection of the cervical sympathetic trunk in anterolateral oblique corpectomy: A new cadaveric demonstration

The cervical oblique corpectomy (OC) approach has the advantages of no grafting or instrumentation necessities and theoretically maintains natural neck motions. However, the risk of cervical sympathetic trunk (CST) injury and Horner’s syndrome is one of the main difficulties of this demanding surgical approach. The upper necks of 3 adult human cadavers (6 sides) were dissected under a Zeiss surgical microscope. OC was performed in a stepwise manner to simulate the surgical procedure. We specifically studied the technique of the protection of the CST during the cervical OC approach. The superior ganglion of the cervical sympathetic chain is located under the prevertebral fascia over the longus capitis muscle at the level of C3 transverse process, while the CST is situated under the prevertebral fascia over the longus colli muscle. The CST courses obliquely from superolateral to inferomedial. The ganglia and CST are carefully dissected; the fascia of the longus colli muscle is cut medially, preferably in the midline over the vertebrae, and the fascia lifted up. Then, the aponeurotic flap is gently retracted laterally to cover the sympathetic chain safely and secured with a 3/0 suture laterally. Preservation of the CST while performing cervical OC is essential to avoid postoperative Horner’s syndrome. The placement of self-retaining retractors, particularly inferiorly, where the sympathetic chain is located more medially, is probably the main cause of its injury. Further studies are needed documenting the incidence of Horner’s syndrome in the application of this technique to live patients.

Anterior and Posterior Segmental Decompression and Fusion for Severely Localized Ossification of the Posterior Longitudinal Ligament of the Cervical Spine: Technical Note.

The surgical strategy for severely localized ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is still not straightforward. We describe the surgical technique of extended anterior cervical discectomy and fusion (ACDF) with partial resection of OPLL followed by posterior cervical segmental decompression and fusion (PCDF). This study investigated five patients with severely localized OPLL with an occupying ratio more than 60%. Extended ACDF comprising a modified technique with a trans-unco-discal approach and partial oblique corpectomy was first attempted to achieve neural decompression of the spinal cord and nerve roots at the most prominent level of the OPLL. The OPLL was partially resected to reduce the axial occupying ratio or ensure that the OPLL did not exceed the imaginary line between the midpoint between C2 and C7 on sagittal images. PCDF was then performed to achieve satisfactory decompression of neural elements and cervical stability. One patient underwent one-stage surgery and the remaining four patients underwent two-stage surgery. No patients received spinal cerebrospinal fluid (CSF) drainage and demonstrated CSF leakage after surgery. All patients showed acceptable or satisfactory functional recovery. No instrumentation-related complications were encountered. Radiological analysis demonstrated that all except one patient (OPLL associated with ankylosing spinal hyperostosis) revealed improvements in local angle, C2–7 angle and cervical tilt angle. This anterior and posterior segmental decompression and fusion for severely localized OPLL of the cervical spine remains technically demanding in some parts, but can offer satisfactory decompression of neural elements and stabilization of the cervical spine when applied appropriately.

Expansile manubriotomy for ventral cervicothoracic junction disease.

Cervicothoracic junction can be approached anteriorly, anterolaterally, posterolaterally, and posteriorly. The anterior approaches in this region best address the ventral vertebral body disease but may cause significant morbidity. Twelve patients with their disease process located ventral to the spinal cord in the cervicothoracic junction underwent expansile manubriotomy and corpectomy. Eleven patients underwent fusion. One patient underwent an oblique corpectomy. All patients had their disease process from T1 to T3 vertebral levels. After dissection, the manubrium was cut open in the midline until the sternal notch. Further manubrial cut was extended laterally to just below the second rib. A self-retaining retractor was placed and opened. This gave an additional exposure of 10 cm from the midline towards the right side. It also opened the thoracic inlet. The superior mediastinum was dissected. Brachiocephalic vessels were looped down and a plane was made between the carotid artery laterally, and the trachea and esophagus medially. The prevertebral fascia was reached and opened to access the vertebral body. The procedure could be carried out successfully in all the patients. A patient with uncontrolled diabetes mellitus and end-stage renal disease with pyogenic epidural abscess succumbed to her illness after 3 weeks. Expansile manubriotomy is technically feasible, less invasive, and least morbid of all the anterior approaches for accessing the anteriorly located disease process above the T4 vertebral level.

Oblique corpectomy in the cervical spine.

A narrative review. A literature review of studies reporting on the application of oblique corpectomy (OC) in various pathologies of the cervical spine. UK. A search was carried out using the PubMed and Google Scholar up to 18 March 2017. Finally, 26 studies met the inclusion criteria. A multilevel OC shows good clinical outcomes in various pathologies in the cervical spine. The clinical improvement in cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament was found to be over 70%. OC allows wide anterior decompression of the spinal cord and complete unilateral nerve root decompression. The approach carries a risk of Horner's syndrome, vertebral artery and accessory nerve injury. OC does not compromise spine stability and osteoarthrodesis with bone grafting is not necessary. Spinal motions are preserved and appear close to normal. OC can be applied in patients with a low fusion rate such as the elderly, diabetics, and heavy smokers. Furthermore, OC was found to be an optimal approach for exta-intradural tumors of the cervical spine. OC seems to be a valid alternative for the management of multisegmental CSM in selected cases. It should not be considered a first-line treatment strategy due to the relatively high morbidity. There are no studies comparing OC without fusion to other treatment options in CSM. Therefore, rigorous prospective studies using validated outcome measures with long-term follow-up are required.

Oblique Cervical Corpectomy in the Management of Unilateral Multilevel Spondylotic Radiculopathy Associated With Myelopathy

Background Data: Oblique cervical corpectomy involves direct decompression of the spinal cord as well as the ipsilateral nerve root but does not require bone fusion or postoperative immobilization. This approach preserves the motion unit anatomically and decreases the risk of adjacent segment disease.Purpose: is to assess the indications, safety, efficacy and complications of oblique cervical corpectomy in the management of unilateral cervical spondylotic radiculopathy associated with myelopathy.Study Design: A prospective clinical case study.Patients and Methods: This study conducted on twelve patients with unilateral cervical spondylotic radiculopathy associated with myelopathy refractory to non-surgical measures for at least 6 months in the period between October 2013 and November 2015. The diagnosis was confirmed by clinical and radiological data. All patients were operated upon at Cairo university hospitals and Al-Haram hospital. Outcome of patients was categorized according to the modified Japanese Orthopaedic Association (mJOA) Scale and the recovery rate was calculated.Results: in this study the average age of presentation was 51 years, the male to female ratio was1:1, and the average duration of symptoms was 11.7 months. Eight cases had right sided radiculopathy and 4 cases had left sided radiculopathy. The most common presenting symptom after brachialgia was neck pain (100%). The most common sign was motor weakness (100%). Most common operated level was C5 and C6 oblique corpectomy. Excellent and good outcomes of patients were obtained in 83.3%. There was statistically significant improvement in the post-operative mJOA score in comparison to the pre-operative. The mean follow up period was 16.5 months with no reported recurrence, instability, progressive kyphosis, vertebral collapse nor other late complications like adjacent segment disease.Conclusion: Oblique corpectomy is a good alternative to conventional median corpectomy and fusion in selected cases for the treatment of unilateral multilevel spondylotic radiculopathy and myelopathy. By avoiding the use of implants and fusion in oblique corpectomy, the procedure is cost effect with no fusion-related complications particularly adjacent segment disease. (2017ESJ130)

Managing Spondylotic Cervical Myeloradiculopathy Using Oblique Cervical Corpectomy

IntroductionThe technique of oblique cervical corpectomy describes preservation of significant portion of the anterior and lateral aspects of the vertebral body.1 In 1999, Ozer et al described a te...

Multilevel oblique corpectomies as an effective surgical option to treat cervical chordoma in a young girl

Chordomas are malignant tumors arising from notochordal remnants. They are the most frequent tumors of the spine after plasmacytomas. Only 6% of chordomas are localized to the cervical level. In young patients, chordomas are rare and unpredictable. Despite this, the treatment of choice remains the total resection, as much as possible, followed by proton beam radiation. This case was managed using a precarotid and retrocarotid approach at the same time. The tumor was completely resected with the edges free from disease. The cervical spine was stabilized with an anterior plating C2-C4. Eighteen months after surgery the patient is still free from illness. Multilevel oblique corpectomies are an available and safe option for the treatment of upper cervical chordomas.

Alternative Procedures for the Treatment of Cervical Spondylotic Myelopathy

In Brief Study Design. Systematic review. Objective. To perform an evidence synthesis of the literature assessing the efficacy of arthroplasty, oblique corpectomy without fusion, and skip laminectomy to treat symptomatic cervical spondylotic myelopathy (CSM). Summary of Background Data. Traditionally, patients with symptomatic cervical spinal cord compression due to degenerative disease have been treated with anterior or posterior approaches or both. Recent reports suggest that there are several nontraditional management strategies that merit attention. The anterior procedures include decompression and anterior reconstruction with an artificial disc and oblique corpectomy without fusion. A posterior option is decompression, using the skip laminectomy technique. Methods. We conducted a systematic search in MEDLINE and the Cochrane Collaboration Library for literature published through October 15, 2012, on human studies published in the English language containing abstracts to answer the following key questions: (1) Is there evidence that artificial disc replacement after neural decompression results in equal or improved outcomes compared with anterior cervical decompression and fusion for CSM? (2) Describe the outcomes of oblique corpectomy without fusion for CSM? (3) Is there evidence that skip laminectomy results in equal or improved outcomes compared with laminoplasty for CSM? Results. The initial literature search yielded 141 unique, potentially relevant citations, which were evaluated against the inclusion/exclusion criteria set a priori. A total of 10 studies were selected for inclusion. For question 1, 2 studies suggested that neurological outcomes favored artificial disc replacement compared with anterior cervical decompression and fusion, whereas functional and pain outcomes were inconsistently reported. For question 2, 5 reported case series suggested favorable neurological, functional, and pain outcomes associated with oblique corpectomy in subjects with CSM, compared with the pretreatment condition. For question 3, 3 studies comparing laminoplasty with skip laminectomy suggested similar neurological outcomes between treatment groups, although functional and pain outcomes were inconsistently reported. Conclusion. A paucity of high-quality literature exists regarding treatment outcomes associated with arthroplasty, oblique corpectomy without fusion, and skip laminectomy for symptomatic CSM. Comparative prospective studies with long-term follow-up and standardized outcome measures are needed to assess treatment outcomes associated with these alternative techniques appropriately. Evidence-Based Clinical Recommendations. Recommendation 1. No recommendation can be made from comparative literature regarding treatment outcomes comparing ADR with ACDF for CSM. Overall Strength of Evidence. Insufficient Strength of Recommendation. Strong Recommendation 2. No recommendation can be made from comparative literature regarding treatment outcomes comparing laminoplasty with skip laminectomy for CSM. Overall Strength of Evidence. Low Strength of Recommendation. Strong Summary Statements. Oblique corpectomy is an option in selected cases of CSM. It should not be considered a first-line treatment strategy because of the relatively high morbidity associated with this procedure. A systematic review of the literature was performed to assess the efficacy of arthroplasty, oblique corpectomy without fusion, and skip laminectomy for cervical spondylotic myelopathy. The authors found a relative lack of high-quality data comparing these so-called “alternative” techniques with standard surgical decompression with or without fusion.

Answer to the Letter to the Editor of J.M. Duart Clemente et al. concerning “multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion” by AG Chacko, M Joseph, MK Turel, K Prabhu, RT Daniel, KS Jacob (2012) Eur Spine J. 2012;21(7):1360–1367

We thank J.M. Duart Clemente et al. for their interest in our article and raising important issues. Interestingly, the incidence of preoperative neck pain was low in our series despite this being a younger cohort of patients without degenerated and fused spines. In addition, neck pain was not a complaint noted during the follow-up period though we have not presented this in the results. We agree that the main goal of surgery is decompression for neurological improvement and not motion preservation. Ours was a unique group of younger patients with soft discs that stands in contrast to the older set of patients with degenerated and largely fused spines reported in Western series [1]. Having performed the oblique corpectomy with good outcomes, we noted the preservation of motion in the short term as a secondary finding that has not been reported previously with this technique. We have also documented a reduction in cervical motion with longer follow-up indicating that the body tends to fuse the spine with production of anterior osteophytes in this relentlessly progressive degenerative disease [2]. Furthermore, the analysis of data from our consecutive series of 153 patients demonstrated that the neurological function and thereby functional outcome was markedly improved following oblique corpectomy. This improved status remained without secondary worsening on long-term follow-up [3]. The technique of oblique corpectomy ensures the removal of the entire posterior surfaces of the affected vertebrae compressing the cord at presentation. The subsequent “cervicoarthrosis” that could reform on the long term are predominantly at the anterior surfaces of the vertebrae and cannot, therefore, endanger the decompressed spinal cord. This would explain the lack of progressive neurological deterioration at least due to a compressive element at the segments treated. We agree wholeheartedly that although motion preservation is not the primary objective of this surgery, we could avoid or at least retard the development of adjacent segment disease. Long-term follow-up is, of course, mandatory to ensure that these patients do not develop progressive kyphosis or adjacent segment disease.

Clinico-biomechanical considerations on oblique corpectomy. Response to: Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion (by A.G. Chacko et al.)

We read with interest the article by Chacko et al. [1] “Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion”; the authors are to be congratulated for their series shown in the article. Certainly, oblique corpectomy described and divulged by George [2] may be an alternative for decompression without fusion in ankylosed spines. It allows for full anterior foraminotomy with direct proximal root control, as well as central canal decompression in patients suffering from stenotic myelopathy. Some complications have been described as Horner’s syndrome, mostly transient. This procedure is interesting for patients that are not candidates for posterior decompressive procedures because of non-lordotic alignment and in whom instability is discarded with preoperative flexion–extension X-rays and not expected because of the degenerated discs and less bone removal, not needing additional instrumentation. This technique requires a learning curve and good patients’ selection, as well as vertebral artery control without remarkable reported vascular complications. We would like to discuss a couple of points. Cervicoarthrosis—the cause of stenotic myelopathy—may be silent, but when it “wakes up” most of the times shows as neck pain. On the other hand, patients treated with anterior decompressive and reconstructive procedures have less postoperative residual axial neck pain than after posterior procedures. According to some other groups which do not restrict the technique to kyphotic alignment, some patients may develop new axial pain (as well as kyphosis) [3], though most of patients with preoperative neck pain improved on pain and most of those without it stayed the same, though few in the latter group worsened a little bit [4]. The goal of surgery is improvement of neurological compromise and decrease in pain, not keeping motion; the need for pain-killers is neither assessed pre and postoperatively nor compared with standard anterior corpectomy and fusion (ACF), so we suggest that in the future it could be investigated whether there is any difference, in patients treated with this technique in comparison with the standard. Another concern is on the biomechanical consequences on the long term. Osteophytes are thought to be the attempt of the body trying to immobilize the unstable and painful segment. The biomechanical study for this surgical technique used non-collapsed disc specimens [5] and quantified the destabilizing effect of it, though kinematics is altered considerably less than that for standard corpectomy (even after plating). Given the kyphosing effect of this technique in the mentioned young population (1:3) with relatively healthy non-collapsed discs and thus mobile function kept, concern raises about what the future holds for these segments; motion preservation may be important specially in young patients, but it should not compromise future neurological function.

Clinical and radiological outcomes in 153 patients undergoing oblique corpectomy for cervical spondylotic myelopathy

Objective. To document the clinical and radiological outcomes in a large series of patients undergoing the oblique cervical corpectomy (OCC) for spondylotic myelopathy. Materials and methods. We retrospectively analyzed our series of 153 patients undergoing OCC for cervical spondylotic myelopathy (CSM) over the last 10 years. A mean clinical follow-up of 3 years was obtained in 125 patients (81.7%), while 117 patients (76.5%) were followed up radiologically. Neurological function was measured by the Nurick grade and the modified Japanese Orthopedic Association score (JOA). Plain radiographs and magnetic resonance images (MRI) were reviewed. Results. Ninety-two percent were men with a mean age of 51 years and a mean duration of symptoms of 18 months. Sixty-one had a single level corpectomy, 66 had a 2-level, 24 had a 3-level, and two had a 4-level OCC. There was statistically significant improvement (p < 0.05) in both the Nurick grade and the JOA score at mean follow-up of 34.6 ± 25.4 months. Permanent Horner's syndrome was seen in nine patients (5.9%), postoperative C5 radiculopathy in five patients (3.3%), dural tear with CSF leak in one patient (0.7%), and vertebral artery injury in one patient (0.7%). Of the 117 patients who were followed up radiologically, five patients (4.3%) developed an asymptomatic kyphosis of the cervical spine while 22 patients (25.6%) with preoperative lordotic spines had a straightening of the whole spine curvature. Conclusions. The OCC is a safe procedure with good outcomes and a low morbidity for treating cervical cord compression due to CSM. This procedure avoids graft-related complications associated with the central corpectomy, but is technically demanding.

Reduction in range of cervical motion on serial long-term follow-up in patients undergoing oblique corpectomy for cervical spondylotic myelopathy

To determine whether motion preservation following oblique cervical corpectomy (OCC) for cervical spondylotic myelopathy (CSM) persists with serial follow-up. We included 28 patients with preoperative and at least two serial follow-up neutral and dynamic cervical spine radiographs who underwent OCC for CSM. Patients with an ossified posterior longitudinal ligament (OPLL) were excluded. Changes in sagittal curvature, segmental and whole spine range of motion (ROM) were measured. Nathan's system graded anterior osteophyte formation. Neurological function was measured by Nurick's grade and modified Japanese Orthopedic Association (JOA) scores. The majority (23 patients) had a single or 2-level corpectomy. The average duration of follow-up was 45 months. The Nurick's grade and the JOA scores showed statistically significant improvements after surgery (p < 0.001). 17% of patients with preoperative lordotic spines had a loss of lordosis at last follow-up, but with no clinical worsening. 77% of the whole spine ROM and 62% of segmental ROM was preserved at last follow-up. The whole spine and segmental ROM decreased by 11.2° and 10.9°, respectively (p ≤ 0.001). Patients with a greater range of segmental movement preoperatively had a statistically greater range of movement at follow-up. The analysis of serial radiographs indicated that the range of movement of the whole spine and the range of movement at the segmental spine levels significantly reduced during the follow-up period. Nathan's grade showed increase in osteophytosis in more than two-thirds of the patients (p ≤ 0.01). The whole spine range of movement at follow-up significantly correlated with Nathan's grade. Although the OCC preserves segmental and whole spine ROM, serial measurements show a progressive decrease in ROM albeit without clinical worsening. The reduction in this ROM is probably related to degenerative ossification of spinal ligaments.

Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion

To document the neurological outcome, spinal alignment and segmental range of movement after oblique cervical corpectomy (OCC) for cervical compressive myelopathy. This retrospective study included 109 patients--93 with cervical spondylotic myelopathy and 16 with ossified posterior longitudinal ligament in whom spinal curvature and range of segmental movements were assessed on neutral and dynamic cervical radiographs. Neurological function was measured by Nurick's grade and modified Japanese Orthopedic Association (JOA) scores. Eighty-eight patients (81%) underwent either a single- or two-level corpectomy; the remaining (19%) undergoing three- or four-level corpectomies. The average duration of follow-up was 30.52 months. The Nurick's grade and the JOA scores showed statistically significant improvements after surgery (p < 0.001). The mean postoperative segmental angle in the neutral position straightened by 4.7 ± 6.5°. The residual segmental range of movement for a single-level corpectomy was 16.7° (59.7% of the preoperative value), for two-level corpectomy it was 20.0° (67.2%) and for three-level corpectomies it was 22.9° (74.3%). 63% of patients with lordotic spines continued to have lordosis postoperatively while only one became kyphotic without clinical worsening. Four patients with preoperative kyphotic spines showed no change in spine curvature. None developed spinal instability. The OCC preserves segmental motion in the short-term, however, the tendency towards straightening of the spine, albeit without clinical worsening, warrants serial follow-up imaging to determine whether this motion preservation is long lasting.

Cervical Spondylotic Myelopathy Treated with Multilevel Oblique Corpectomy. A Review of 29 Cases.

Study Design: We reviewed our surgical experience and results in 29 patients operated upon by multiple oblique corpectomy without fusion for cervical spondylotic myelopathy. Objective: To review the safety, efficacy and surgical experience of multiple oblique corpectomy in carefully selected 29 patients, through anterolateral corridor to thecervical spine without the need for vertebral fusion or stabilization. Methods: Between March 2007 and April 2011, 29 patients have been treated with multiple oblique corpectomy technique for cervical spondylotic myelopathy.The functional status was assessed using the modified Japanese Orthopedic Association Score preoperatively and at 1,6,12 months postoperatively. Radiological Assessment was done preoperatively with MRI, CT scan and plain radiograph, and postoperatively on the following 1,6,12 months after surgery and routinely prior to discharge. Results: Among the 29 patients (19 males and 10 females) with a mean preoperative duration of symptoms for of 11.7 months. Satisfactory significant recovery occurred in 20 patients, 5 patients had no clinical improvement and 4 patients had variable degrees of clinical deterioration. Only one patient showed an evidence of spinal instability postoperatively. Conclusion: The multiple oblique corpectomy is a safe and effective technique in removal of the anterior compressing spurs to the spinal cord. No fusion is required regardless the number of the levels. The short recovery period, few complications rate with satisfactory significant outcome make this technique a better surgical option for cervical spondylotic myelopathy in selected patients.(2012ESJ003)

Oblique corpectomy to manage cervical myeloradiculopathy.

Background. The authors describe a lateral approach to the cervical spine for the management of spondylotic myeloradiculopathy. The rationale for this approach and surgical technique are discussed, as well as the advantages, disadvantages, complications, and pitfalls based on the author's experience over the last two decades. Methods. Spondylotic myelo-radiculopathy may be treated via a lateral approach to the cervical spine when there is predominant anterior compression associated with either spine straightening or kyphosis, but without vertebral instability. Results. By using a lateral approach, the lateral aspect of the cervical spine and the vertebral artery are easily reached and visualized. Furthermore, the lateral part of the affected intervertebral disc(s), uncovertebral joint(s), vertebral body(ies), and posterior longitudinal ligament can be removed as needed to decompress nerve root(s) and/or the spinal cord. Conclusion. 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.