The antero-lateral approach with corpectomy in the management of the ventral meningioma of the spinal canal

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

ABSTRACT

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.

Lateral approach for recurrent unilateral cervical radiculopathy after anterior discectomy with fusion. Report of two cases

Recurrent radiculopathy after anterior cervical discectomy with fusion (ACDF) occurs in approximately 4% of cases. The main obstacles of revision surgery after ACDF via the same approach are scar tissue and arthrodesis. We present two patients with recurrent symptoms after ACDF who underwent revision surgery using an alternative, less invasive lateral approach (LA). These two patients both presented with recurrent unilateral cervical radiculopathy due to progression of intervertebral foraminal stenosis. The second patient also presented with paraparesis of the lower limbs and central stenosis. Anterior foraminotomy in the first case and oblique corpectomy in the second were performed via the LA. The previously implanted interbody cages were left intact and no new fusion procedures were needed. No spinal instability or symptom relapse was observed in follow-up. The lateral approach to the cervical spine enables direct and effective decompression of neural structures without violation of previously achieved interbody fusion.

Oblique corpectomy in the cervical spine

STUDY DESIGN

A narrative review.

OBJECTIVES

A literature review of studies reporting on the application of oblique corpectomy (OC) in various pathologies of the cervical spine.

SETTING

UK.

METHODS

A search was carried out using the PubMed and Google Scholar up to 18 March 2017. Finally, 26 studies met the inclusion criteria.

RESULTS

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.

CONCLUSIONS

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.