The first experience of using the “skip corpectomy” method in the surgical treatment of cervical spondylotic myelopathy

OBJECTIVE. Evaluation of the effectiveness and safety of the “skip corpectomy” method in the surgical treatment of cervical spondylotic myelopathy.

MATERIALS AND METHODS. The study included 7 patients with cervical myelopathy due to extended stenosis of the cervical spine, operated using the “skip corpectomy” method. The clinical examination included an assessment of the degree of neurological disorders according to the modified scale of the Japanese Orthopedic Association (JOA), followed by the calculation of the degree of recovery (recovery rate) and Nurick, pain syndrome — according to the visual analogue scale (VAS). Verification of the diagnosis was based on the data of spondylography, magnetic resonance and computed tomography. The indication for surgical treatment was the presence of conduction disorders, the spondylotic genesis of which was confirmed by neuroimaging methods.

RESULTS. In the late postoperative period, a decrease in the intensity of pain according to VAS was achieved by 2–4 points (average — 3.1). When assessing the degree of myelopathy in the postoperative period according to the JOA, Nurick scale and calculating the recovery index (the average recovery rate is 42.5 %), all patients showed significant changes in the neurological status for the better. In all cases, the follow-up examination confirmed the usefulness of decompression and completed spinal fusion.

CONCLUSION. The “skip corpectomy” method makes it possible to perform a complete decompression of the spinal cord in case of extended stenosis of the cervical spine and minimize the risk of complications typical for multilevel corporectomy. The recovery rate indicates the effectiveness of the method in the surgical treatment of cervical myelopathy caused by multilevel stenosis. However, for a reliable assessment of the method, further studies on sufficient clinical material are needed.

1. Bailey RW , Badgley CE. Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg Am. 1960; 42: 565–594.

2. Robinson RA , Smith GW . Anterolateral disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955;96: 223–224.

3. Cloward RB. The anterior approach for ruptured cervical discs. J Neurosurg. 1958; 15:602–614. https://doi.org/10.3171/jns.1958.15.6.0602

4. Dalbayrak S, Yilmaz M, Naderi S. “Skip” corpectomy in the treatment of multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament. J Neurosurg Spine. 2010; 12(1): 33–38. https://doi.org/10.3171/2009.7.SPINE08965

5. Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV. Early reconstruction failures after multilevel cervical corpectomy. Spine. 2003; 28: 140–142. https://doi.org/10.1097/00007632‑200301150‑00009

6. Ashkenazi E, Smorgick Y, Rand N, Millgram MA , Mirovsky Y, Floman Y. (2005) Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique. J Neurosurg Spine. 2005; 3(3): 205–209. https://doi.org/10.3171/spi.2005.3.3.0205

7. Qian L, Jiang S, Liu Z, Cheng L, Zeng Z, Jia Y, Li X , Wang H. Comparison of the safety and efficacy of anterior “skip” corpectomy versus posterior decompression in the treatment of cervical spondylotic myelopathy. J Orthopaedic Surg Res. 2014; 9(1):1–6. https://doi.org/10.1186/s13018–014–0063-x

8. Eck KR, Lenke LG , Bridwell KH, Gilula LA , Lashgari CJ, Riew KD. Radiographic assessment of anterior titanium mesh cages. J Spinal Disord. 2000; 13: 501–509. https://doi.org/10.1097/00002517‑200012000‑00006

9. Feng F, Ruan W, Liu Z, Li Y, Cai L. A nterior versus posterior approach for the treatment of cervical compressive myelopathy due to ossification of the posterior longitudinal ligament: A systematic review and meta-analysis. International Journal of Surgery. 2016; 27: 26–33. https://doi.org/10.1016/j.ijsu.2016.01.038

10. Li H, Dai LY . A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament. Spine. 2011; 11(11): 1049–1057. https://doi.org/10.1016/j.spinee.2011.09.008

11. Arima H, Naito K, Yamagata T, Kawahara S, Ohata K, Takami T. Anterior and posterior segmental decompression and fusion for severely localized ossification of the posterior longitudinal ligament of the cervical spine: technical note. Neurologia Medico-Chirurgica. 2019; 59: 238–245. https://doi.org/10.2176/nmc.tn.2018–0324

12. Lisitsky I. Y u., Lychagin A . V., Zarov A. Y u., Korkunov A . L ., Cherepanov V. G ., Vyazankin I. A . Successful surgical treatment of patient with cervical myelopathy due to ossification of the posterior longitudinal ligament: a rare clinical observation and literature review. Burdenko’s Journal of Neurosurgery. 2021; 4: 69–76. (In Russ). https://doi.org/10.17116/neiro20218504169