Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases

The authors describe a surgical procedure called multiple subtotal somatectomy. This operation is indicated when canal stenosis is caused by posterior protrusions of the anterior wall of the spinal canal (due to osteophytes, posttraumatic deformities, or tumoral lesions) involving three or more cervical segments. The procedure's principal phases are (1) removal up to the posterior longitudinal ligament of the central portion of three or more vertebral bodies, and (2) insertion into the prepared trench (15-mm wide) of an autologous graft, previously obtained from the iliac wing. Thirty-nine cases are presented (29 spondylosic myelopathies, 10 posttraumatic myelopathies), with follow-up periods varying from 6 months to 13 years. All grafts united, and 36 patients were benefited, while only three failed to improve.