Displaced bony disk material will be removed from your neck. This displaced material is causing a problem by pressing on nerves. It will be replaced with bone taken from your hip or the fibula bone in your lower leg. During the operation, an incision (cut) will be made on your neck (see the diagram below). The size of this incision will depend on the extent of your problem. A second incision will be made on the front of your hip or leg (see the diagram). Bone will be removed from your hip or leg and will be placed in your neck. This transfer is called a bone graft. The surgery may take about four hours. If you have one or two vertebras repaired (a single-level corpectomy), you will probably be sent directly to a general patient unit after surgery. Your hospital stay will be two to three days. If you have two or more bones removed (a multiple-level corpectomy), you will probably be sent to the intensive care unit (ICU). During surgery a plastic breathing tube will be inserted down your throat, to keep your airway open. This is necessary because of swelling in your neck. You will remain in the ICU while you have a breathing tube. Most patients stay in the ICU one to two days. Then you will be sent to a general patient unit for two to five days. Incisions are usually closed with stitches and may be secured with Steri-strip tapes; paper like strips that stick to your skin and help keep the sides of the incision from shifting. The stitches will dissolve completely. The Steri-strips will fall off by themselves, usually within two weeks of surgery.
All patients underwent preoperative MR imaging and CT studies. The position of the manubrium and the great vessels relative to the level of the pathological entity was assessed in each patient. In two patients, both of whom underwent a C-7 corpectomy, a standard horizontal cervical incision was used. The other six patients underwent surgery via an extended cervical approach, which required that an incision be made along the medial border of the sternocleidomastoid muscle, ending at the manubrium. In two patients, the incision was continued caudally in the midline to allow for resection of the rostral third of the manubrium. A left-sided incision was used in seven patients; the anatomical position of one tumor necessitated the use of a right-sided incision in a single case. A left-sided incision was preferred because of the course of the RLN. A standard cervical dissection along the medial border of the sternocleidomastoid muscle, medial to the carotid sheath, was performed to expose the anterior surface of the lower cervical spine. The dissection was extended caudally, angling beneath the manubrium or accompanied by a partial resection of the manubrium. When required, up to 3 cm of the manubrium was resected using a Leksell rongeur. Although resection of the head of the clavicle was not necessary in this series, it has been described and may increase exposure as well.[13,14] A table-mounted self-retaining retractor system, used in all cases, proved to be very helpful in retracting mediastinal contents. The thoracic duct may be ligated and divided if it cannot be retracted out of the field. A narrow, malleable blade was used for caudal retraction. The use of corpectomy, in contrast to discectomy, allowed for visualization of the thecal sac following bone removal. A nearly "end on" view of the caudal VB may be obtained. Following decompression of the spinal cord and nerve roots, a fibular allograft was used as a load-bearing strut. In all cases an anterior cervical plate was implanted to provide immediate rigidity to the construct. The use of variable-angle screws was helpful for the placement of the plates caudally. The angle required for screw placement often required contouring of the plate in addition to the use of variable-angle screws. Four of the eight patients also underwent posterior stabilization procedures for the treatment of gross instability. Postoperative immobilization therapy consisted of a rigid cervical collar in six patients and a Minerva brace in two. The duration of immobilization therapy was 6 weeks in all patients.