The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies

Clinical article

Restricted access


Whereas standard anterior approaches for thoracolumbar corpectomies have commonly been used, the transpedicular technique is increasingly used to perform corpectomies from a posterior approach. The authors conducted a study to analyze whether there was a difference in outcomes by comparing transpedicular corpectomies to standard anterior thoracolumbar corpectomies.


The senior author performed thoracolumbar corpectomies in 80 patients between 2004 and 2008. The authors reviewed medical records and follow-up data, consisting of clinic visits, radiographs, or telephone interviews. Neurological outcome, complications, operative times, revision surgery rates, and estimated blood loss (EBL) were evaluated.


Thirty-four patients underwent transpedicular corpectomies, and 46 patients underwent anterior thoracolumbar approaches. Single-level transpedicular corpectomies appear to be comparable to anterior-only corpectomies in terms of EBL, operative time, and complication rates. There was a higher complication rate, increased EBL, and longer operative time with anterior-posterior corpectomies compared with transpedicular corpectomies. Patients undergoing transpedicular corpectomies had a greater recovery of neurological function than those in whom anterior-approach corpectomies were performed.


The transpedicular corpectomy appears to have a comparable morbidity rate to anterior-only corpectomies, but its morbidity rate is lower than that of anterior-posterior corpectomies.

Abbreviations used in this paper: ASIA = American Spinal Injury Association; EBL = estimated blood loss.

Article Information

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:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Intraoperative fluoroscopic image demonstrating cage positioning from the transpedicular approach.

  • View in gallery

    Intraoperative photograph demonstrating final construct with cage in place after a 3-level transpedicular corpectomy and trap-door rib-head osteotomy.

  • View in gallery

    Artist's illustration demonstrating placement of expandable cage after 3-level transpedicular corpectomy and rib head disarticulation.

  • View in gallery

    Artist's illustrations demonstrating the 3 techniques of rib-head disarticulation, rib-head osteotomy, and trap-door ribhead osteotomy.



Bilsky MHBoland PLis ERaizer JJHealey JH: Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine 25:224022502000


Chen YJChang GCChen HTYang TYKuo BIHsu HC: Surgical results of metastatic spinal cord compression secondary to non-small cell lung cancer. Spine 32:E413E4182007


Chiriano JAbou-Zamzam AM JrUrayeneza OZhang WWCheng W: The role of the vascular surgeon in anterior retroperitoneal spine exposure: preservation of open surgical training. J Vasc Surg 50:1481512009


Chou DEltgroth MYang ILu DManley G: Rib head disarticulation for multilevel transpedicular thoracic corpectomies and expandable cage reconstruction. Neurol India 57:4694742009


Chou DLu DChi JWang V: Rib-head osteotomies for posterior placement of expandable cages in the treatment of metastatic thoracic spine tumors. J Clin Neurosci 15:104310472008


Chou DWang VY: Trap-door rib-head osteotomies for posterior placement of expandable cages after transpedicular corpectomy: an alternative to lateral extracavitary and costotransversectomy approaches. J Neurosurg Spine 10:40452009


D'Aliberti GTalamonti GVilla FDebernardi ASansalone CVLaMaida A: Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases. J Neurosurg Spine 9:4664822008


Dvorak MFKwon BKFisher CGEiserloh HL IIIBoyd MWing PC: Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection. Spine 28:9029082003


Hunt TShen FHArlet V: Expandable cage placement via a posterolateral approach in lumbar spine reconstructions. Technical note. J Neurosurg Spine 5:2712742006


Nadir ASahin EOzum UKaradag OTezeren GKaptanoglu M: Thoracotomy in spine surgery. Thorac Cardiovasc Surg 56:4824842008


Pettiford BLSchuchert MJJeyabalan GLandreneau JRKilic ALandreneau JP: Technical challenges and utility of anterior exposure for thoracic spine pathology. Ann Thorac Surg 86:176217682008


Resnick DKBenzel EC: Lateral extracavitary approach for thoracic and thoracolumbar spine trauma: operative complications. Neurosurgery 43:7968031998


Sasani MOzer AF: Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine 34:E33E402009


Shehadi JASciubba DMSuk ISuki DMaldaun MVMcCutcheon IE: Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients. Eur Spine J 16:117911922007


Shen FHMarks IShaffrey COuellet JArlet V: The use of an expandable cage for corpectomy reconstruction of vertebral body tumors through a posterior extracavitary approach: a multicenter consecutive case series of prospectively followed patients. Spine J 8:3293392008


Snell BENasr FFWolfla CE: Single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis: surgical technique and results in 15 patients. Neurosurgery 58:4 SupplONS263ONS2692006


Street JFisher CSparkes JBoyd MKwon BPaquette S: Single-stage posterolateral vertebrectomy for the management of metastatic disease of the thoracic and lumbar spine: a prospective study of an evolving surgical technique. J Spinal Disord Tech 20:5095202007


Wiggins GCMirza SBellabarba CWest GAChapman JRShaffrey CI: Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors. Neurosurg Focus 11:6e42001




All Time Past Year Past 30 Days
Abstract Views 68 68 23
Full Text Views 58 58 17
PDF Downloads 199 199 23
EPUB Downloads 0 0 0


Google Scholar