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

Clinical article

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Object

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.

Methods

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.

Results

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.

Conclusions

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: choud@neurosurg.ucsf.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    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.

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