Mini-open transpedicular corpectomies with expandable cage reconstruction

Technical note

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Transpedicular corpectomies are frequently used to perform anterior surgery from a posterior approach. Minimally invasive thoracolumbar corpectomies have been previously described, but these are performed through a unilateral approach. Bilateral access must be obtained for a circumferential decompression when using such techniques. The authors describe a technique that allows for a mini-open transpedicular corpectomy, 360° decompression, and expandable cage reconstruction through a single posterior approach. This is performed using percutaneous pedicle screws, the trap-door rib-head osteotomy, and a single midline fascial exposure. The authors describe this technique with intraoperative photos and a video demonstrating the technique.

Abbreviation used in this paper: PLL = posterior longitudinal ligament.

Article Information

Current affiliation for Dr. Lu: Department of Neurosurgery, University of California, Los Angeles, California.

Address correspondence to: Dean Chou, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Box 0112, San Francisco, California 94143-0112. email: choud@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online December 17, 2010; DOI: 10.3171/2010.10.SPINE091009.

© AANS, except where prohibited by US copyright law.

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Figures

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    Intraoperative photographs. Planning of the skin incision (a) based on radiographs, making the skin incision but preserving the fascia (b), cannulating the pedicles under radiography (c), and inserting the K-wires (d).

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    Intraoperative photographs. After the pedicle is tapped, a screw is inserted (a), the screw placement is confirmed under radiography (b), screws are inserted 2 levels above and below the planned corpectomy site (c), a midline fascial opening is made and a retractor is placed (d).

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    Intraoperative photographs. A laminectomy is performed (a), transverse processes are removed and a trap-door rib-head osteotomy is performed (b), the tubular retractor can be replaced with a more mobile cerebellar retractor without any further fascial opening (c), and the cage is placed by pushing against the trap-door rib-head osteotomy (d).

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    Intraoperative photographs. The cage is inserted past the spinal cord (a), cage placement is confirmed with fluoroscopy (b), the rods are inserted and set screws are locked (c), and crosslinks are placed (d).

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    Intraoperative photographs. Minimally invasive corpectomy performed with 5 separate incisions (a), cage placement for L-1 corpectomy with nerve preservation (b), cosmetic difference between 5 separate stab incisions (c) versus single midline skin incision with separate fascial openings (d).

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