Optimal anatomical angle and distance for drilling in cervical oblique corpectomy: A surgical anatomical study

Abstract

Background: One of the difficulties of oblique corpectomy, less discussed in the literature, is the problem of how to achieve an optimum corpectomy. Therefore, this anatomico-radiological study was conducted to shed light on the use of the microscope at an appropriate angle and optimum drill distances in clinical cases undergoing cervical oblique corpectomy surgery. Materials and Methods: We examined the average distance of the diagonal line extending from the medial aspect of the ipsilateral vertebral foramen to the contralateral pedicle in cervical computed tomography -angiography axial scans in four cervical vertebrae, C3, C4, C5, and C6. We also measured the average angle between this diagonal trajectory and the horizontal line, making a total of 712 measurements in 89 patients. Results: We found that horizontal drilling with an average length of 23–26 mm at an acute angle of about 22° –23° is optimal for adequate decompression of the spinal cord in the oblique corpectomy approach. Depending on the patient and the level of the vertebra, the distance and the angle of the horizontal drilling may range from 18 mm to 31 mm and from 15° to 33°, respectively. Conclusions: For an optimum cervical oblique corpectomy that provides adequate spinal cord decompression and maintains spinal stability, it is necessary to operate under a surgical microscope positioned at an acute angle and to know the horizontal drilling distance.