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Robert Goodkin, David R. Haynor and Michel Kliot

A nterior vertebrectomy has become popular for the treatment of cervical myelopathy caused by cervical spondylosis with extensive posterior osteophyte formation, posterior longitudinal ligament hypertrophy or ossification, cervical kyphosis, or tumors or infections of the vertebral body. One of the factors believed to affect surgical outcome is the completeness of the vertebrectomy laterally, which can affect decompression of the spinal canal and spinal cord. We report the use of intraoperative ultrasound to determine the extent of vertebral body resection

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Deepak Awasthi and Rand M. Voorhies

A nterior cervical vertebrectomy with interbody fusion is one of the surgical procedures used for multilevel cervical disease, including cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL). 6, 7, 9, 16, 17 This report discusses our technique in performing this procedure using a high-speed drill and bone-bank fibular strut graft. This technique seeks to combine the relative safety of the Smith-Robinson operation with the improved exposure of the Cloward procedure. Its most frequent application is for multilevel cervical disease

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Harel Deutsch, Marc Arginteanu, Karen Manhart, Noel Perin, Martin Camins, Frank Moore, A. Abe Steinberger and Donald J Weisz

monitoring in all clinical situations in which it is applied. False-positive results are relatively common, and false-negative results also occur. In several case reports the authors have described occurrences in which SSEPs remained normal; however, patients were noted to have neurological deficits postoperatively. 4, 5, 15, 19 The treatment of fractures, tumors, infections, and other maladies of the thoracic spine sometimes requires an anterior approach in vertebrectomy and placement of instrumentation. 1, 16, 28, 29 In our institution we have routinely used SSEP

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Ziya L. Gokaslan, Julie E. York, Garrett L. Walsh, Ian E. McCutcheon, Frederick F. Lang, Joe B. Putnam Jr., David M. Wildrick, Stephen G. Swisher, Dima Abi-Said and Raymond Sawaya

permits minimal removal of uninvolved bone, rapid removal of tumor, effective reconstruction of the weight-bearing anterior column, short-segment fixation, and improved wound healing. The purpose of this study was to describe our surgical procedure and its results with respect to pain relief, neurological recovery, and risk of complications in patients with metastatic tumors who underwent transthoracic vertebrectomy via a sternotomy, thoracotomy, or thoracoabdominal approach. Clinical Material and Methods Patient Population We performed 523 spinal operations

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David W. Cahill and Rakesh Kumar

patients, nine underwent subtotal vertebrectomy and anterior and posterior reconstruction via a single midline posterior approach, and they comprise the study population. Patient Population There were five men and four women who ranged in age from 50 to 80 years. Primary tumor types were adenocarcinoma of the lung (three patients), colon (two patients), prostate (one patient), or breast (one patient) and squamous cell carcinoma of the larynx (two patients). In each patient there was metastatic involvement of a single vertebral segment between T-2 and L-3. All

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Julie E. York, Garrett L. Walsh, Frederick F. Lang, Joe B. Putnam, Ian E. McCutcheon, Stephen G. Swisher, Ritsuko Komaki and Ziya L Gokaslan

and nerve roots ( Fig. 1 inset ). Fig. 1. Artist's illustration. Inset: The drawing demonstrates the surgical incisions: a standard posterolateral thoracotomy is performed to gain access to the chest cavity, whereas posterior midline exposure is needed for the laminectomy and dorsal instrumentation and fusion. The primary illustration depicts the surgical field after the tumor (along with the invaded chest wall) has been completely mobilized from the surrounding structures and reflected inferiorly. Complete laminectomy and partial vertebrectomy at the T

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Khandkar A. Kawsar, Robin Bhatia and Adrian C. T. H. Casey

defect following en bloc resection of a giant cell tumor of the thoracic spine. Spinal cord herniation can be posttraumatic, iatrogenic, or spontaneous, but this is the first reported iatrogenic case following anterior vertebrectomy for tumor resection. Case Report History and Examination A 44-year-old woman underwent en bloc resection of a giant cell tumor from the spine at the T6–8 level with insertion of an anterior Moss cage and plate. For completion of resection, a T-5 vertebrectomy was also performed, followed by stabilization using posterior

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Ziya L. Gokaslan, Julie E. York, Garrett L. Walsh, Ian E. McCutcheon, Frederick F. Lang, Joe B. Putnam Jr., David M. Wildrick, Stephen G. Swisher, Dima Abi-Said and Raymond Sawaya

Anterior approaches to the spine for the treatment of spinal tumors have gained acceptance; however, in most published reports, patients with primary, metastatic, or chest wall tumors involving cervical, thoracic, or lumbar regions of the spine are combined. The purpose of this study was to provide a clear perspective of results that can be expected in patients who undergo anterior vertebral body resection, reconstruction, and stabilization for spinal metastases that are limited to the thoracic region.

Outcome is presented for 72 patients with metastatic spinal tumors who were treated by transthoracic vertebrectomy at The University of Texas M. D. Anderson Cancer Center. The predominant primary tumors included renal cancer in 19 patients, breast cancer in 10, melanoma or sarcoma in 10, and lung cancer in nine patients. The most common presenting symptoms were back pain, which occurred in 90% of patients, and lower-extremity weakness, which occurred in 64% of patients. All patients underwent transthoracic vertebrectomy, decompression, reconstruction with methylmethacrylate, and anterior fixation with locking plate and screw constructs. Supplemental posterior instrumentation was required in seven patients with disease involving the cervicothoracic or thoracolumbar junction, which was causing severe kyphosis. After surgery, pain improved in 60 of 65 patients. This improvement was found to be statistically significant (p < 0.001) based on visual analog scales and narcotic analgesic medication use. Thirty-five of the 46 patients who presented with neurological dysfunction improved significantly (p < 0.001) following the procedure. Thirty-three patients had weakness but could ambulate preoperatively. Seventeen of these 33 regained normal strength, 15 patients continued to have weakness, and one patient was neurologically worse postoperatively. Of the 13 preoperatively nonambulatory patients, 10 could walk after surgery and three were still unable to walk but showed improved motor function. Twenty-one patients had complications ranging from minor atelectasis to pulmonary embolism. The 30-day mortality rate was 3%. The 1-year survival rate for the entire study population was 62%.

These results suggest that transthoracic vertebrectomy and spinal stabilization can improve the quality of life considerably in cancer patients with spinal metastasis by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbidity and mortality.

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Risheng Xu, Giannina L. Garcés-Ambrossi, Matthew J. McGirt, Timothy F. Witham, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Daniel M. Sciubba

decompression of the spinal cord, complete vertebrectomy, and anterior spinal column reconstruction. This treatment can be accomplished from an anterior, posterior, or a combined anterior-posterior approach. Currently, within each general category of surgical approach, different techniques exist. Thus, with the anterior (or transthoracic) approach, the T1–2 vertebrae may be accessed with or without sternotomy and anterior neck dissection. 9 , 42 , 54 The T3–4 region may be reached via the “trap door” exposure, an amalgam of the anterolateral cervical approach, a partial

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Tony Feuerman, Paul S. Dwan and Ronald F. Young

tumor. Operation The thoracic cavity was entered anterolaterally through the T9-10 interspace, and the left lung was deflated with the aid of a double-lumen endotracheal tube. Following reflection of the pleura, an x-ray film was obtained to confirm the location of the tumor. On palpation, the body of T-10 was noted to be hyperostotic anteriorly and laterally with an irregularly raised cortical surface. The vertebrectomy was started by removing the entire left lateral aspect of the corpus with a high-speed drill and a 7-mm gouge. Immediately after the