Ann. Pak. Inst. Med. Sci. 2010; 6(1): 28-30

Objective: To assess the role of corpectomy along with excision of disc in multiple cervical discs prolapse.
Study Design: Descriptive Case Series
Place and Duration: Department of Neurosurgery, PIMS, Islamabad from 1996 - 2009.
Materials and Methods: 48 patients, 46 male & 2 female between age group of 30-65 years under went anterior approach for multiple cervical disc prolapse during 1996-2009. 35 patients had two level disc prolapse while 13 presented with 3 level disc prolapse. 38 patients presented with myelopathy while 10 patients had combined symptoms of myelopathy and brachalgia. Single or two level corpectomy with excision of disc was done in all the cases followed by single graft placement and casper plating.
Results: Relief in symptoms of myelopathy & brachelgia were observed in immediate post operative period. Recovery on follow up was remarkable in myelopathy which reached its maximum level of 96% in one year.
Conclusion: Corpectomy in multiple cervical disc prolapse provides us with double advantage of adequate decompression, saves hazard of multiple grafts thus giving good neurological results and minimize the complications of graft displacement.
Keywords: Corpectomy, Disc Prolapse, Multilevel Disc Prolaspe


Introduction

During the last three decades, the anterior approach to the cervical spine has been increasingly preferred in the operative treatment of herniated cervical disc. Anterior approach to the cervical spine has low morbidity, leaves cosmetically acceptable scar and provides direct access to the areas of most pathology.¹ Surgical options include.²

• Smith Robinson technique – disc excision with no decompression of the canal and horsshose graft.
• Cloward technique – disc excision without canal decompression and onlay/chip graft.
• Subtotal vertebrectomy and strut grafting with fibula (autogenous or allograft no difference in fusion rates
in some reports) with or without decompression and with or without internal fixation.

In all these procedures excellent outcome for neck pain (96%) and radiculopathy (97%) was noted, but an average of less favourable improvement in myelopathy (60%) has been reported.³
Literature reports inadequate results with discectomy alone in multiple level cervical disc disease^4-8 so we report a series with an objective to access the role of corpectomy along with excision of disc followed by fusion in these cases leading to very rewarding results. 87-96% patients with multilevel cervical disc prolapse present with myelopathy while those with single level cervical disc prolapse, 94% present with beachalgia.⁹ In most of the reported series no difference was observed in patients who underwent anterior cervical disectomy with or without fusion in a single level disc presenting with brachalgia.10 However, less favourable results have been reported in patients presenting with myelopathy in multiple level disc who underwent discectomy followed by fusion.^11-13 It has been reported that the discectomy is safe and effective procedure for radiculopathy and less for myelopathy.⁵
Corpectomy is usually performed in trauma tumours and caries spine. Our study suggests that it is also useful in multiple level disc disease so there is a new indication, that is 2-3 level cervical disc prolapse where 87-96% patients mostly present with myelopathy .^{14, 15} We recommend corpectomy along with excision of disc a level above and a level below followed by fusion leading to most favourable results especially in myelpathy and high percentage of pain relief in brachalgia.