Skip Corpectomies for Anterior Cervical Decompression: Technical Note

Charles B. Agbi, MB, BS, FRCSEd(SN), FRCS(C)
Scott Paquette, MD

Multilevel corpectomies (vertebrectomies) are sometimes necessary for adequate decompression of the cervical spinal cord when the compression is not confined to the disc space level. Such situations arise in the treatment of certain cases of extensive cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament (OPLL), and anterior spinal eqidural abscesses.

The length of graft required for vertebral column reconstruction in these cases sometimes limits the choice of graft material to either autologous fibula or allograft long bone. The latter is often in short supply because of acquisition and preparation constraints, and the former poses significant harvesting problems for the neurosurgeon with limited experience in limb surgery.We developed the technique of "skip" corpectomy to allow the utilization of short grafts such as can be easily obtained from autologous iliac crest for vertebral column reconstruction.

Technique:

In this technique, the middle third of the interventing vertebral body in (typically) a three–level vertebrectomy is preserved as a bridge, allowing the use of two short autologous iliac crest grafts instead of a single long bone graft. Locking plate and screw fixation was applied in all cases. We have employed this technique successfully in 4 cases.

Postoperative follow up showed adequate decompression and solid fusion of all treated levels. We have found this technique to be an effective and safe alternative in situations where long bone grafts are unavailable.