Minimally invasive lateral extracavitary corpectomy: cadaveric evaluation model and report of 3 clinical cases

Laboratory investigation

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  • 1 Department of Neurosurgery, Northwestern University, Chicago, Illinois;
  • 2 The Spine Clinic of Los Angeles, Good Samaritan Hospital, An Affiliate of the University of Southern California, Los Angeles, California; and
  • 3 Department of Orthopedic Surgery, The First Affiliated Hospital of People's Liberation Army General Hospital, Beijing, China
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Object

In this paper, the authors' goal was to demonstrate the clinical and technical nuances of a minimally invasive lateral extracavitary approach (MI-LECA) for thoracic corpectomy and anterior column reconstruction.

Methods

A cadaveric feasibility study and the subsequent application of this approach in 3 clinical cases are reported. Six procedures were completed in 3 human cadavers. Minimally invasive, extrapleural thoracic corpectomies were performed with the aid of a 24-mm tubular retraction system, using a posterolateral incision and an oblique approach angle. Fluoroscopy and postprocedural CT scanning, using 3D volumetric averaging software, was used to evaluate the degree of bone removal and decompression. Three clinical cases, including a T-11 burst fracture, a T-7 plasmacytoma, and a T4–5 vertebral body (VB) tuberculosis lesion, were treated using the approach.

Results

At 6 cadaveric levels, the mean circumferential volumetric decompression was 48% ± 16%, and the mean resection of the VB was 72% ± 13%. The mean change in anterior and posterior vertebral height with expansion of the corpectomy cage was 47 and 61 mm, respectively. There were no violations of the pleura or dura. Pedicle screw reliability was 95.8% (23 of 24 screws) with a single lateral breach. All 3 patients in the clinical cohort had excellent clinical outcomes. There was a single pleural tear requiring chest tube drainage. Operative images and a video clip are provided to illustrate the approach.

Conclusions

A minimally invasive lateral extracavitary thoracic corpectomy has the ability to provided excellent spinal cord decompression and VB resection. The procedure can be completed safely and successfully with minimal blood loss and little associated morbidity. This approach has the potential to improve upon established traditional open corridors for posterolateral thoracic corpectomy.

Abbreviations used in this paper:LECA = lateral extracavitary approach; MI-LECA = minimally invasive LECA; VB = vertebral body.

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Contributor Notes

Address correspondence to: Zachary A. Smith, M.D., Good Samaritan Hospital, Department of Neurosurgery, 1245 Wilshire Boulevard, #717, Los Angeles, California 90017. email: zsmithmd@gmail.com.

Please include this information when citing this paper: published online March 9, 2012; DOI: 10.3171/2012.2.SPINE11128.

  • 1

    Adamson TE: Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg 95:1 Suppl 5157, 2001

    • Search Google Scholar
    • Export Citation
  • 2

    Arnold PM, , Baek PN, , Bernardi RJ, , Luck EA, & Larson SJ: Surgical management of nontuberculous thoracic and lumbar vertebral osteomyelitis: report of 33 cases. Surg Neurol 47:551561, 1997

    • Search Google Scholar
    • Export Citation
  • 3

    Benzel EC: The lateral extracavitary approach to the spine using the three-quarter prone position. J Neurosurg 71:837841, 1989

  • 4

    Bohlman HH, & Zdeblick TA: Anterior excision of herniated thoracic discs. J Bone Joint Surg Am 70:10381047, 1988

  • 5

    Capener N: The evolution of lateral rhachotomy. J Bone Joint Surg Br 36-B 173179, 1954

  • 6

    Chen LH, , Chen WJ, , Niu CC, & Shih CH: Anterior reconstructive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine. Arch Orthop Trauma Surg 120:2731, 2000

    • Search Google Scholar
    • Export Citation
  • 7

    Chou D, & Lu DC: Mini-open transpedicular corpectomies with expandable cage reconstruction. Technical note. J Neurosurg Spine 14:7177, 2011

    • Search Google Scholar
    • Export Citation
  • 8

    Currier BL, , Eismont FJ, & Green BA: Transthoracic disc excision and fusion for herniated thoracic discs. Spine (Phila Pa 1976) 19:323328, 1994

    • Search Google Scholar
    • Export Citation
  • 9

    Delfini R, , Di Lorenzo N, , Ciappetta P, , Bristot R, & Cantore G: Surgical treatment of thoracic disc herniation: a reappraisal of Larson's lateral extracavitary approach. Surg Neurol 45:517523, 1996

    • Search Google Scholar
    • Export Citation
  • 10

    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
  • 11

    Dinh DH, , Tompkins J, & Clark SB: Transcostovertebral approach for thoracic disc herniations. J Neurosurg 94:1 Suppl 3844, 2001

  • 12

    Faciszewski T, , Winter RB, , Lonstein JE, , Denis F, & Johnson L: The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine (Phila Pa 1976) 20:15921599, 1995

    • Search Google Scholar
    • Export Citation
  • 13

    Fessler RG: Minimally invasive spine surgery. Neurosurgery volume>issue>SiiiSiv, 2002

  • 14

    Fessler RG, , O'Toole JE, , Eichholz KM, & Perez-Cruet MJ: The development of minimally invasive spine surgery. Neurosurg Clin N Am 17:401409, 2006

    • Search Google Scholar
    • Export Citation
  • 15

    Fessler RG, & Sturgill M: Review: complications of surgery for thoracic disc disease. Surg Neurol 49:609618, 1998

  • 16

    Graham AW III, , Mac Millan M, & Fessler RG: Lateral extracavitary approach to the thoracic and thoracolumbar spine. Orthopedics 20:605610, 1997

    • Search Google Scholar
    • Export Citation
  • 17

    Guiot BH, , Khoo LT, & Fessler RG: A minimally invasive technique for decompression of the lumbar spine. Spine (Phila Pa 1976) 27:432438, 2002

    • Search Google Scholar
    • Export Citation
  • 18

    Holly LT, , Schwender JD, , Rouben DP, & Foley KT: Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus 20:3 E6, 2006

    • Search Google Scholar
    • Export Citation
  • 19

    Isaacs RE, , Podichetty VK, , Santiago P, , Sandhu FA, , Spears J, & Kelly K, : Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine 3:98105, 2005

    • Search Google Scholar
    • Export Citation
  • 20

    Khoo LT, , Beisse R, & Potulski M: Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery 51:5 Suppl S104S117, 2002

    • Search Google Scholar
    • Export Citation
  • 21

    Khoo LT, & Fessler RG: Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery 51:5 Suppl S146S154, 2002

    • Search Google Scholar
    • Export Citation
  • 22

    Khoo LT, , Smith ZA, , Asgarzadie F, , Barlas Y, , Armin SS, & Tashjian V, : Minimally invasive extracavitary approach for thoracic discectomy and interbody fusion: 1-year clinical and radiographic outcomes in 13 patients compared with a cohort of traditional anterior transthoracic approaches. Clinical article. J Neurosurg Spine 14:250260, 2011

    • Search Google Scholar
    • Export Citation
  • 23

    Kim DH, , O'Toole JE, , Ogden AT, , Eichholz KM, , Song J, & Christie SD, : Minimally invasive posterolateral thoracic corpectomy: cadaveric feasibility study and report of four clinical cases. Neurosurgery 64:746753, 2009

    • Search Google Scholar
    • Export Citation
  • 24

    Larson SJ, , Holst RA, , Hemmy DC, & Sances A Jr: Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine. J Neurosurg 45:628637, 1976

    • Search Google Scholar
    • Export Citation
  • 25

    Maiman DJ, , Larson SJ, , Luck E, & El-Ghatit A: Lateral extracavitary approach to the spine for thoracic disc herniation: report of 23 cases. Neurosurgery 14:178182, 1984

    • Search Google Scholar
    • Export Citation
  • 26

    Ménard V: Causes de la paraplégie dans de maladie de Pot, son traitment chirurgical par l'ouverture directe du foyer tuberculeaux des vertèbres. Rev Orthop 5:4764, 1894

    • Search Google Scholar
    • Export Citation
  • 27

    Musacchio M, , Patel N, , Bagan B, , Deutsch H, , Vaccaro AR, & Ratliff J: Minimally invasive thoracolumbar costotransversectomy and corpectomy via a dual-tube technique: evaluation in a cadaver model. Surg Technol Int 16:221225, 2007

    • Search Google Scholar
    • Export Citation
  • 28

    Ransohoff J, , Spencer F, , Siew F, & Gage L Jr: Transthoracic removal of thoracic disc. Report of three cases. J Neurosurg 31:459461, 1969

    • Search Google Scholar
    • Export Citation
  • 29

    Regan JJ, , Mack MJ, & Picetti GD III: A technical report on video-assisted thoracoscopy in thoracic spinal surgery. Preliminary description. Spine (Phila Pa 1976) 20:831837, 1995

    • Search Google Scholar
    • Export Citation
  • 30

    Resnick DK, & Benzel EC: Lateral extracavitary approach for thoracic and thoracolumbar spine trauma: operative complications. Neurosurgery 43:796803, 1998

    • Search Google Scholar
    • Export Citation
  • 31

    Rosenthal D, , Marquardt G, , Lorenz R, & Nichtweiss M: Anterior decompression and stabilization using a microsurgical endoscopic technique for metastatic tumors of the thoracic spine. J Neurosurg 84:565572, 1996

    • Search Google Scholar
    • Export Citation
  • 32

    Ryang YM, , Oertel MF, , Mayfrank L, , Gilsbach JM, & Rohde V: Standard open microdiscectomy versus minimal access trocar microdiscectomy: results of a prospective randomized study. Neurosurgery 62:174182, 2008

    • Search Google Scholar
    • Export Citation
  • 33

    Schmidt MH, , Larson SJ, & Maiman DJ: The lateral extracavitary approach to the thoracic and lumbar spine. Neurosurg Clin N Am 15:437441, 2004

    • Search Google Scholar
    • Export Citation
  • 34

    Sundaresan N, , Shah J, , Foley KM, & Rosen G: An anterior surgical approach to the upper thoracic vertebrae. J Neurosurg 61:686690, 1984

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