Abstract
INTRODUCTION: Oblique corpectomy is a surgical technique of spinal cord decompression through a limited bone resection of the posterolateral corner of the vertebral bodies. In this study the results of this technique applied in cases of spondylotic myelopathy and tumours are presented.
METHODS: The oblique corpectomy is achieved through a lateral approach with control and sometimes transposition of the VA. It can be used at any level from C2 to T1 and on as many levels as required from 1 to 5. It was mostly applied on cervical spondylotic myelopathy (N=157) or radiculopathy (N=89) but also on hourglass tumours (neurinomas N=67, meningiomas N=7, hemangioblastoma N=1, paraganglioma N=1) and different tumours N=49 involving the lateral part of the vertebral body such as osteoid osteomas N=8, chordomas N=11, aneurysmal cyst N=3, sarcomas N=4. The total series includes 126 tumours. In most cases preservation of the main part of the vertebral bodies permitted to avoid bone grafting and plating. However stabilisation procedure is still necessary when more than one disc is resected and when the discs are soft and not collapsed.
RESULTS: Excellent decompression was obtained in every case of spondylotic myelopathy and radiculopathy. Clinical results are similar to those obtained by any other techniques of decompression through anterior approach but without the complications related to grafting and plating. Improvement of the pre-operative score was noted in 79% of patients with myelopathy stabilisation in 13% and worsening in 8%. In patients with radiculopathy, good and excellent results were obtained in 85%. A better decompression of the intervertebral foramen is achieved through the oblique corpectomy since the whole length of the cervical nerve root from the dural sac to the vertebral artery can be decompressed. Instability requiring further stabilisation procedure was observed only in three cases which in fact were pre-operatively unstable.
Complete tumour resection was achieved in every case especially for the lateral part located into the intervertebral foramen and around the vertebral artery. Even tumours extending from the outside of the spine to the intradural space could be entirely removed through the same approach. Grafting and plating were realised in 13 out of the 126 cases of tumour.
CONCLUSION: Oblique corpectomy technique is a safe technique which permits to decompress the spinal cord and cervical nerve roots from spondylotic elements and tumours.
As compared to other techniques, it achieves a better decompression on the lateral part of the spinal canal and on the intervertebral foramen up to the vertebral artery. In many cases it does not require any complementary stabilisation technique and avoids the use of instrumentation.
These abstracts were prepared by Dr Robert J. Moore. Correspondence should be addressed to him at Spine Society of Australia, Institute of Medical and Veterinary Science, The Adelaide Centre for Spinal Research, Frome Road, Adelaide, South Australia 5000.
