Anterior Cervical Corpectomy and Fusion
What is it?
Anterior Cervical Corpectomy and Fusion (ACCF) is a surgical procedure primarily aimed at addressing multilevel cervical spondylotic myelopathy, significant disc herniations, tumors, infections, or traumatic injuries of the cervical spine. The procedure involves the removal of one or more vertebral bodies (corpectomy) and the intervertebral discs to decompress the spinal cord and nerve roots, followed by fusion to stabilize the spine.
ACCF is particularly beneficial in cases where multilevel decompression is required. It allows for direct spinal cord and nerve roots decompression, often resulting in significant improvement in neurological function and pain relief. Fusion provides the necessary spinal stability post-decompression, preventing future deformity or instability.
Postoperative care involves immobilization with a cervical collar, pain management, and gradual rehabilitation. Radiographic follow-up is essential to monitor graft integration and spinal alignment.
Procedure
ACCF begins with an anterior approach to the cervical spine. The affected vertebral body and adjacent discs are meticulously removed, taking care not to damage the spinal cord and nerve roots. The resection’s extent is critical and tailored based on the pathology and the levels involved.
The reconstruction of the spine post-corpectomy is crucial. This is typically achieved using a structural graft (autograft, allograft, or synthetic cage) placed into the defect. Various factors, including patient age, bone quality, and the extent of reconstruction needed influence the graft choice. The graft is supplemented with anterior plating and screws to provide immediate stability and facilitate fusion.
The surgery requires careful navigation around critical structures like the esophagus, trachea, and major blood vessels. Intraoperative imaging, such as fluoroscopy, is employed for accurate graft placement and hardware positioning.