Minimally Invasive Corpectomy in Metastatic Thoracolumbar Spine Disease:The Posterolateral Transpedicular Approach
Study design: Retrospective review of prospectively collected data.
Background: There is no consensus regarding the ideal approach for corpectomy in destructive metastatic thoracolumbar spine disease. Many surgical techniques have been described but none has proved its definite superiority. The main drawback of these procedures is directly related to the morbidity of the approach. As one-stage minimally invasive pedicle screw fixation combined with mini-open posterolateral transpedicular corpectomy for treatment of thoracolumbar metastatic lesions is gaining popularity, its efficacy has yet to be established.
Purpose: The purpose of this study is to report operative data, clinical and radiological outcomes of patients undergoing minimally invasive stabilization, decompression, transpedicular corpectomy and anterior column reconstruction of thoracolumbar metastatic disease at our institutions.
Methods: Forty patients underwent minimally invasive pedicle screws stabilization, mini open decompression and transpedicular corpectomy for treatment of single-level metastatic destruction of the thoracic or lumbar spine. All patients were neurologically intact. There were 19 males and 21 females with an average age of 58 years.
Results: The mean follow-up was 17 months (7—2 1 months). The mean operative time was 256 min (230-390 min) and the mean blood loss was 1350 mL. VAS was significantly improved from 6.7 to 0.7 at last follow-up. Vertebral kyphosis decreased by 16◦ to 7.8◦ postoperatively (P < 0.001). Local kyphosis and percentage of collapse were also significantly improved from 8◦ to 5.6◦ and from 35% to 16% at last follow-up. No patient worsened his or her neurological condition postoperatively.
Conclusion: Minimally invasive transpedicular corpectomy seems to be a safe and effective technique to manage thoracolumbar fractures without neurological impairment.
Aebi M. Spinal metastasis in the elderly[J]. Eur Spine J, 2003,12(Suppl 2):S202–13.
DeWald RL, Bridwell KH, Prodromas C, Rodts MF. Reconstructive spinal surgery as palliation for metastatic malignancies of the spine[J]. Spine (Phila Pa 1976). 1985,10(1):21–26.
Enkaoua EA, Doursounian L, Chatellier G, Mabesoone F, Aimard T, Saillant G. Vertebral metastases: a critical appreciation of the preoperative prognostic tokuhashi score in a series of 71 cases[J]. Spine (Phila Pa 1976), 1997,22(19):2293–2298.
Khodadadyan-Klostermann C, Schaefer J, Schleicher P, Pflugmacher R, Eindorf T, Haas NP, Kandziora F. Expandable cages: biomechanical comparison of different cages for ventral spondylodesis in the thoracolumbar spine[J]. Chirurg,2004,75(7):694–701.
Knop C, Lange U, Bastian L, Blauth M. Three-dimensional motion analysis with Synex. Comparative biomechanical test series with a new vertebral body replacement for the thoracolumbar spine[J]. Eur Spine J,2000,9(6):472–485.
Lange U, Knop C, Bastian L, Blauth M. Prospective multicenter study with a new implant for thoracolumbar vertebral body replacement[J]. Arch Orthop Trauma Surg,2003,123(5):203–208.
Dunn HK. Anterior spine stabilization and decompression for thoracolumbar injuries[J]. Orthop Clin North Am,1986,17(1):113–119.
Gokaslan ZL, York JE, Walsh GL, McCutcheon IE, Lang FF, Putnam JB Jr,et al. Transthoracic vertebrectomy for metastatic spinal tumors[J].J Neurosurg 1998,89(4):599–609.
Arts MP, Peul WC. Vertebral body replacement systems with expandable cages in the treatment of various spinal patholo¬gies: a prospectively followed case series of 60 patients[J]. Neu¬rosurgery,2008,63(3):537–545.
Schnake KJ, Stavridis SI, Krampe S, Kandziora F. Additional anterior plating enhances fusion in anteroposteriorly stabilized thoracolumbar fractures[J]. Injury,2014,45(4):792–798.
Bilsky MH, Boland P, Lis E, Raizer JJ,Healey JH. Singlestage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases[J]. Spine,2000,25(7):2240–2250.
Chou D, Wang VY. Trap-door rib-head osteotomies for posterior placement of expandable cages after transpedicular corpectomy: an alternative to lateral extracavitary and costotransversectomy approaches[J]. J Neurosurg Spine,2009,10(1):40–45.
Crocker M, James G, Ibrahim A, Thomas N, Chitnavis B. Posteriorapproach vertebrectomy in the thoracolumbar spine with expandable cage reconstruction: indications and techniques based on eight cases[J]. Br J Neurosurg,2008,22(2):235–240.
Metcalfe S, Gbejuade H, Patel NR. The posterior transpedicular approach for circumferential decompression and instrumented stabilization with titanium cage vertebrectomy reconstruction for spinal tumors: consecutive case series of 50 patients[J]. Spine,2012,37(16):1375–1383.
Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion[J]. Spine,2003,28(15 Suppl):S26–35.
Palmisani M, Gasbarrini A, Barbanti Brodano G, De lure F, Cappuccio M, Boriani L, et al. Minimally invasive percutaneous fixation in the treatment of thoracic and lumbar spine fractures[J]. Eur Spine J,2009,18(Suppl 1):S71–74.
Chou D, Lu DC. Mini-open transpedicular corpectomies with expandable cage reconstruction. Technical note[J]. J Neurosurg Spine,2011,14(1):71–77.
Chou D, Lu D, Chi J, Wang V. Rib-head osteotomies for posterior placement of expandable cages in the treatment of metastatic thoracic spine tumors[J]. J Clin Neurosci,2008,15(9):1043–1047.
Dvorak MF, Kwon BK, Fisher CG, Eiserloh HL 3rd, Boyd M, Wing PC. Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection[J]. Spine,2003,28(9):902–908.
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[J]. Spine,1995,20(14):1592–1599.
Knop C, Lange U, Reinhold M, Blauth M. Vertebral body replacement with Synex in combined posteroanterior surgery for treatment of thoracolumbar injuries[J]. Oper Orthop Traumatol,2005,17(3):249–280.
Lowery GL, Harms J. Titanium surgical mesh for vertebral defect replacement and intervertebral spacers, in Thalgott JS, Aebi M (eds): Manual of Internal Fixation of the Spine (Principles and Techniques in Spine Surgery)[M]. Philadephia: Lippincott-Raven, 1996:127–146.
McDonough PW, Davis R, Tribus C, Zdeblick TA. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation[J]. Spine (Phila Pa 1976),2004,29(17):1901–1908.
Konstantinidis L, Mayer E, Strohm PC, Hirschmüller A, Südkamp NP, Helwig P. Early surgery-related complications after anteroposterior stabilization of vertebral body fractures in the thoracolumbar region[J]. J Orthop Sci, 2010,15(2):178–184.
Danisa OA, Shaffrey CI, Jane JA, et al. Surgical approaches for the correction of unstable thoracolumbar burst fractures: a retrospective analysis of treatment outcomes[J]. J Neurosurg, 1995,83(6):977–983.
Shen FH, Marks I, Shaffrey C, Ouellet J, Arlet V. The use of an expandable cage for corpectomy reconstruction of vertebralbral body tumors through a posterior extracavitary approach: a multicenter consecutive case series of prospectively followed patients[J]. Spine J,2008,8(2):329–339.
Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation[J]. J Spinal Disord Tech,2005,18(6):485–488.
Esses SI, Botsford DJ, Kostuik JP. Evaluation of surgical treatment for burst fractures[J]. Spine (Phila Pa 1976), 1990,15(7):667–673.
Park MS, Deukmedjian AR, Uribe JS. Minimally invasive anterolateral corpectomy for spinal tumors[J]. Neurosurg Clin N Am,2014,25(2):317–325.
Lu DC, Lau D, Lee JG, Chou D. The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies[J]. J Neurosurg Spine,2010,12(6):583–591.
Wang ST, Ma HL, Liu CL, Yu WK, Chang MC, Chen TH. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study[J]. Spine (Phila Pa 1976),2006,31(23):2646–2652.
Logroscino CA, Proietti L, Tamburrelli FC. Minimally invasive spine stabilisation with long implants[J]. Eur Spine J, 2009,18(Suppl 1):75–81.
Nourbakhsh A, Chittiboina P, Vannemreddy P, Nanda A, Guthikonda B. Feasibility of thoracic nerve root preservation in posterior transpedicular vertebrectomy with anterior column cage insertion: a cadaveric study[J]. J Neurosurg Spine,2010,13(5):630–635.
Fuentes S, Blondel B, Metellus P, Gaudart J, Adetchessi T, Dufour H. Percutaneous kyphoplasty and pedicle screw fixation for the management of thoraco-lumbar burst fractures[J]. Eur Spine J,2010,19(8):1281–1287.
Korovessis P, Hadjipavlou A, Repantis T. Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures[J]. Spine (Phila Pa 1976), 2008,33(6):658–667.
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.