Anterior Thoracic Spine Reconstruction Using a Titanium Mesh Cage and Pedicled Rib Flap

OʼShaughnessy, Brian A.; Ondra, Stephen L.; Ganju, Aruna; Said, Hakim K.; Few, Julius W.; Liu, John C.

doi:10.1097/01.brs.0000226017.28265.a6

Cited by 6 publications

(2 citation statements)

References 31 publications

(39 reference statements)

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“…Some surgical series that analyzed their results following cage fixation postthoracic vertebrectomy for a variety of indications have reported worsening of the kyphotic angle postoperatively, albeit the change was minimal. [29][30][31][32] Conclusions A transthoracic approach is the gold standard surgical strategy in dealing with GCTDs. A trench vertebrectomy via a thoracotomy allows safe identification of normal dura on either side of the compressed segment prior to performing a diskectomy.…”

Section: Discussionmentioning

confidence: 99%

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Management of Giant Calcified Thoracic Disks and Description of the Trench Vertebrectomy Technique

Al-Mahfoudh

Mitchell

Wilby

et al. 2015

Global Spine Journal

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Study Design Case series and review of the literature.Objective To review the management of giant calcified disks in our large cohort and compare with the existing literature. We discuss our surgical technique.Methods Twenty-nine cases of herniated thoracic disk between 2000 and 2013 were reviewed. Eighteen patients were identified as having giant calcified thoracic disks, defined as diffusely calcified disks occupying at least 40% of the spinal canal. Demographic data was collected in addition to presentation, imaging findings, operative details, and outcomes using the modified Japanese Orthopaedic Association (mJOA) scale.Results Giant calcified thoracic disks (GCTDs) are unique clinical entities that require special neurosurgical consideration owing to significant (≥40%) involvement of the spinal canal and compression of the spinal cord, often leading to myelopathy. The median age at diagnosis was 51.2 years (range 37 to 70) with the mean duration of presenting symptoms being 9.9 months (range 2 weeks to 3 years). Seventeen (94.4%) patients presented with at least one sign of myelopathy (hyperreflexia, hypertonia, bladder or bowel dysfunction) with the remaining 1 (5.6%) patient presenting with symptoms in keeping with radiculopathy. Thoracotomy was performed on 17 (94.4%) patients, and 1 (5.6%) patient had a costotransverse approach. Mean follow-up was 19.8 months (range 7 months to 2 years). mJOA score improved in 15 (83.3%) patients. mJOA scores in the other patients remained stable.Conclusions GCTDs are difficult neurosurgical challenges owing to their size, degree of spinal cord compression, and consistency. We recommend a trench vertebrectomy via a thoracotomy in their surgical management. This procedure safely allows the identification of normal dura on either side of the compressed segment prior to performing a diskectomy. Excellent fusion rates were achieved with insertion of rib head autograft in the trench.

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Section: Discussionmentioning

confidence: 99%

“…Some surgical series that analyzed their results following cage fixation post–thoracic vertebrectomy for a variety of indications have reported worsening of the kyphotic angle postoperatively, albeit the change was minimal. 29 , 30 , 31 , 32…”

Section: Discussionmentioning

confidence: 99%

Management of Giant Calcified Thoracic Disks and Description of the Trench Vertebrectomy Technique

Al-Mahfoudh

Mitchell

Wilby

et al. 2015

Global Spine Journal

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Intérêt d’un péroné vascularisé pour la reconstruction du rachis dans le cadre d’une neurofibromatose de type 1

Bourdais

Hamel

et al. 2008

Annales de Chirurgie Plastique Esthétique

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Surgical Treatment of Vertebral Osteomyelitis With Recombinant Human Bone Morphogenetic Protein-2

OʼShaughnessy¹,

Kuklo²,

Ondra³

2008

Spine

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Anterior Thoracic Spine Reconstruction Using a Titanium Mesh Cage and Pedicled Rib Flap

Abstract: The use of an integrated rib flap and titanium mesh cage construct appears to be a safe and effective means of providing immediate and substantial anterior column support as well as achieving arthrodesis in challenging fusion candidates.

Cited by 6 publications

References 31 publications

Management of Giant Calcified Thoracic Disks and Description of the Trench Vertebrectomy Technique

Management of Giant Calcified Thoracic Disks and Description of the Trench Vertebrectomy Technique

Intérêt d’un péroné vascularisé pour la reconstruction du rachis dans le cadre d’une neurofibromatose de type 1

Surgical Treatment of Vertebral Osteomyelitis With Recombinant Human Bone Morphogenetic Protein-2

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