Microsurgical Wedge-Corpectomy Without Bone Grafting for Cervical Spondylosis with Myelopathy or Radiculopathy; Experience with Fifty-Eight Operated Levels

W. Michael Vise, MD

An alternative to midline corpectomy, strut grafting, and application of a Halo brace is presented for cervical myelopathy requiring anterior decompression. Wedge–shaped resections of the posterior one–half of adjacent vertebral bodies were performed via an anterior approach through an expanded interspace and a small key–hole opening. This was done in such a way as to preserve an anterior column of support while resecting a large wedge of the vertebral bodies posteriorly. The spine was not destabilized by this procedure. Bone grafting was not required and post–operative bracing was limited to a soft cervical collar.

Fifty–eight levels of wedge corpectomy were performed at adjacent vertebral bodies in forty–three patients. Multilevel wedge corpectomies were performed in 35%. Wedge corpectomies were performed adjacent to radical cervical discectomies in another 14%. Myelopathy was the reason for surgery in 19% of patients. Spondylosis with radiculopathy was the indication in 81%. An Ultra–Power Hall drill with a 4 mm cutting burr was used for bone resection. A microdissector and small bone punches were used to resect calcified PLL from dura. Resection of calcified dura was required in one case. Techniques for extensive bone resection and hemostasis through a small anteriorly placed opening were demanding. An operative time of three hours per interspace was required in cases with severe myelopathy, however, the advantages were early discharge, no donor site pain, no spinal instrumentation, and improved postoperative mobility without a Halo brace. Less extensive wedge corpectomies were required in patients with spondylotic radiculopathy and varying degrees of OPLL. The average hospital stay for all patients was one day. Eighteen operations (42%) were done on an outpatient basis. Complications were minimal. No patients suffered increased neurological deficits. Good to excellent outcomes were achieved in 90% of patients.