Feasibility of thoracic nerve root preservation in posterior transpedicular vertebrectomy with anterior column cage insertion: a cadaveric study

Laboratory investigation

View More View Less
  • Department of Neurosurgery, Louisiana State University Health Sciences Center–Shreveport, Louisiana

Object

Transpedicular thoracic vertebrectomy (TTV) is a safe alternative to the more standard transthoracic approach. A TTV is most commonly used to address vertebral body fractures due to tumor or trauma.

Transpedicular reconstruction of the anterior column with cage/bone traditionally requires unilateral thoracic nerve root sacrifice. In a cadaveric model, the authors evaluated the feasibility of transpedicular anterior column reconstruction without nerve root sacrifice. If feasible, this may be a reasonable approach that could be extended to the lumbar spine where nerve root sacrifice is not an option.

Methods

A TTV was performed in 8 fixed cadaveric specimens. In each specimen, an alternate vertebra (either odd or even) was removed so that single-level reconstruction could be evaluated. The vertebrectomy included facetectomy, adjacent discectomies, and laminectomy; however, the nerve roots were preserved. The authors then evaluated the feasibility of inserting a titanium mesh cage (Medtronic Sofamor Danek) without neural sacrifice.

Results

Transpedicular anterior cage reconstruction could be safely performed at all levels of the thoracic spine without nerve root sacrifice. The internerve root space varied from 18 mm at T2–3 to 27 mm at T11–12; thus, the size of the cage that was used also varied with level.

Conclusions

Cage reconstruction of the anterior column could be safely performed via the transpedicular approach without nerve root sacrifice in this cadaveric study. Removal of the proximal part of the rib in addition to a standard laminectomy with transpedicular vertebrectomy provided an excellent corridor for anterior cage reconstruction at all levels of the thoracic spine without nerve root sacrifice.

Abbreviations used in this paper: PMMA = polymethylmethacrylate; PPI = pedicle-to-pedicle inlet; PTA = posterior transpedicular approach; TTV = transpedicular thoracic vertebrectomy; VB = vertebral body.

Contributor Notes

Address correspondence to: Bharat Guthikonda, M.D., Department of Neurosurgery, LSUHSC–Shreveport, 1501 Kings Highway, Shreveport, Louisiana 71130. email: bguthi@lsuhsc.edu.
  • 1

    Akeyson EW, & McCutcheon IE: Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis. J Neurosurg 85:211220, 1996

    • Search Google Scholar
    • Export Citation
  • 2

    Bilsky MH, , Boland P, , Lis E, , Raizer JJ, & Healey JH: Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine 25:22402249, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Bilsky MH, & Fraser JF: Complication avoidance in vertebral column spine tumors. Neurosurg Clin N Am 17:317329, vii, 2006

  • 4

    Cahill DW, & Kumar R: Palliative subtotal vertebrectomy with anterior and posterior reconstruction via a single posterior approach. J Neurosurg 90:1 Suppl 4247, 1999

    • Search Google Scholar
    • Export Citation
  • 5

    Chen YJ, , Hsu HC, , Chen KH, , Li TC, & Lee TS: Transpedicular partial corpectomy without anterior vertebral reconstruction in thoracic spinal metastases. Spine 32:E623E626, 2007

    • Search Google Scholar
    • Export Citation
  • 6

    Davis C: Partial posterior vertebrectomy for anterior thoracic cord compression. Br J Neurosurg 1:277279, 1987

  • 7

    Deutsch H, , Boco T, & Lobel J: Minimally invasive transpedicular vertebrectomy for metastatic disease to the thoracic spine. J Spinal Disord Tech 21:101105, 2008

    • Search Google Scholar
    • Export Citation
  • 8

    DeWald RL, , Bridwell KH, , Prodromas C, & Rodts MF: Reconstructive spinal surgery as palliation for metastatic malignancies of the spine. Spine 10:2126, 1985

    • Search Google Scholar
    • Export Citation
  • 9

    Fourney DR, , Abi-Said D, , Rhines LD, , Walsh GL, , Lang FF, & McCutcheon IE, : Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization. J Neurosurg 94:2 Suppl 232244, 2001

    • Search Google Scholar
    • Export Citation
  • 10

    Grob D, , Daehn S, & Mannion AF: Titanium mesh cages (TMC) in spine surgery. Eur Spine J 14:211221, 2005

  • 11

    Hardaker WT Jr, , Cook WA Jr, , Friedman AH, & Fitch RD: Bilateral transpedicular decompression and Harrington rod stabilization in the management of severe thoracolumbar burst fractures. Spine 17:162171, 1992

    • Search Google Scholar
    • Export Citation
  • 12

    Hollowell JP, , Vollmer DG, , Wilson CR, , Pintar FA, & Yoganandan N: Biomechanical analysis of thoracolumbar interbody constructs. How important is the endplate?. Spine 21:10321036, 1996

    • Search Google Scholar
    • Export Citation
  • 13

    Johnston FG, , Uttley D, & Marsh HT: Synchronous vertebral decompression and posterior stabilization in the treatment of spinal malignancy. Neurosurgery 25:872876, 1989

    • Search Google Scholar
    • Export Citation
  • 14

    Kanayama M, , Cunningham BW, , Haggerty CJ, , Abumi K, , Kaneda K, & McAfee PC: In vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices. J Neurosurg 93:2 Suppl 259265, 2000

    • Search Google Scholar
    • Export Citation
  • 15

    Kaya RA, & Aydin Y: Modified transpedicular approach for the surgical treatment of severe thoracolumbar or lumbar burst fractures. Spine J 4:208217, 2004

    • Search Google Scholar
    • Export Citation
  • 16

    Magerl F, & Coscia MF: Total posterior vertebrectomy of the thoracic or lumbar spine. Clin Orthop Relat Res 62:6269, 1988

  • 17

    Murrey DB, , Brigham CD, , Kiebzak GM, , Finger F, & Chewning SJ: Transpedicular decompression and pedicle subtraction osteotomy (eggshell procedure): a retrospective review of 59 patients. Spine 27:23382345, 2002

    • Search Google Scholar
    • Export Citation
  • 18

    Pflugmacher R, , Schleicher P, , Schaefer J, , Scholz M, , Ludwig K, & Khodadadyan-Klostermann C, : Biomechanical comparison of expandable cages for vertebral body replacement in the thoracolumbar spine. Spine 29:14131419, 2004

    • Search Google Scholar
    • Export Citation
  • 19

    Sciubba DM, , Gallia GL, , McGirt MJ, , Woodworth GF, , Garonzik IM, & Witham T, : Thoracic kyphotic deformity reduction with a distractible titanium cage via an entirely posterior approach. Neurosurgery 60:4 Suppl 2 223230, 2007

    • Search Google Scholar
    • Export Citation
  • 20

    Tomita K, , Kawahara N, , Kobayashi T, , Yoshida A, , Murakami H, & Akamaru T: Surgical strategy for spinal metastases. Spine 26:298306, 2001

  • 21

    Vrionis FD, & Small J: Surgical management of metastatic spinal neoplasms. Neurosurg Focus 15:5 E12, 2003

  • 22

    Wang JC, , Boland P, , Mitra N, , Yamada Y, , Lis E, & Stubblefield M, : Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1:287298, 2004

    • Search Google Scholar
    • Export Citation
  • 23

    Wang MY, , Kim DH, & Kim KA: Correction of late traumatic thoracic and thoracolumbar kyphotic spinal deformities using posteriorly placed intervertebral distraction cages. Neurosurgery 62:3 Suppl 1 162171, 2008

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 468 313 7
Full Text Views 109 19 2
PDF Downloads 242 22 3
EPUB Downloads 0 0 0