Single-Stage Thoracolumbar Vertebrectomy With Circumferential Reconstruction And Arthrodesis: Surgical Technique And Results In 15 Patients

Snell, Brian E.; Nasr, Fadi F.; Wolfla, Christopher E.

doi:10.1227/01.neu.0000209034.86039.39

Cited by 37 publications

(48 citation statements)

References 23 publications

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“…3,7,10,11 Because of advances in surgical techniques and surgeon comfort, thoracolumbar corpectomies are increasingly performed via a posterior approach. 1,8,9,12,13,16 In our study, we found similar morbidity for the anterior-only and transpedicular approaches with regard to complication rate, EBL, and operative time. However, performing an anterior-posterior approach increased the morbidity much more than the transpedicular approach, with increasing EBL (3154 vs 1857 ml), longer mean surgical times (729 vs 450 minutes), and slightly higher complication rates (41 vs 29%, respectively, although not statistically significant).…”

Section: Discussionsupporting

confidence: 73%

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

Lau²,

Lee³

et al. 2010

SPI

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A nterior spinal pathological entities of the thoracolumbar spine have traditionally been treated by an anterior transthoracic, thoracolumbar, or retroperitoneal approach. Also used has been a posterior surgery via costotransversectomy or extracavitary approaches. The transpedicular corpectomy is a variant of the costotransversectomy and extracavitary approaches in that the rib head is preserved as the corpectomy is being performed, and the corpectomy is performed through the pedicles. Various techniques have been described to deal with the rib head to perform anterior spinal reconstruction. [4][5][6] With advances in surgical techniques, many operations that traditionally have been performed through anterior spinal approaches (including multilevel corpectomies) are now being performed via posterior approaches. We wished to evaluate whether one approach was superior to the other with regard to complications, neurological outcome, morbidity, and other perioperative factors. 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. MethodsMethods. 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 anteriorapproach 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.

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Section: Discussionsupporting

confidence: 73%

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

Lau²,

Lee³

et al. 2010

SPI

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“…The stabilization of the posterior blade allows the anterior blades to be safely deployed to create sufficient access space for discectomy (Figure 3d), corpectomy and implant placement. The exhibition allows direct visualization of the lateral side facilitating the disc discectomy (Figure 3d), corpectomy, and the placement of a prosthetic vertebral body expansion and bone grafting [10]. Discectomies (Figure 3d) are performed both cephalad and caudal to the fracture using a scalpel to incise the anular tissue and a pituitary rongeur or curette to extract the disk material.…”

Section: First Surgical Approach Retroperitoneal Dissectionmentioning

confidence: 99%

The Corpectomy Using Minimally Invasive Access in Thoracolumbar Fractures

Doria¹,

Zachos²,

Muresu³

2012

Orthop Muscul Syst

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Introduction: In our clinic for several years we are pursuing the concept of mini-invasive surgery applied to the spine. Increasingly we have to our attention patients with comorbidities (figure 1) and for this reason could not face a major surgery. In this work we analyze various patients who suffered an osteoporotic vertebral fracture. The fractures on CT and MRI study, presented a minimal back protrusion of the wall with no images related to compression of the structures ( figure 2a, 2b, 2c), but presented deformities,like kyphosis. The deformities in the past would certainly have required anterior surgery and corpectomy with placement of a mesh and interbody stabilization. This method provides access to trans-abdominal peritoneal or retro peritoneal and often requires the collaboration of general and vascular surgeon due to the presence of abdominal viscera and major vessels.

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“…Other indications include the resection of hemivertebrae 4,16 or intravertebral spinal tumors, 1,10,31,37,39 or even, as has recently been described, the shortening of the spine proximal to a tethered region as a novel method of treating tethered spinal cord without the risks of dissection around adhesed nerve roots. 4,12,17 Outcomes After Surgery Studies of pVCR to date have demonstrated it to be a powerful method of focal deformity correction.…”

Section: Surgical Techniquementioning

confidence: 99%

Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review

Dorward¹,

Lenke

2010

FOC

125

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In addressing adult spinal deformities through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. The Ponte or Smith-Petersen osteotomy provides the least correction, but it can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies but carry increased technical demands, longer operative time, and greater blood loss and associated morbidity. Vertebral column resections serve as the most powerful method, providing the most correction in the coronal and sagittal planes, but posing both the greatest technical challenge and the greatest risk to the patient in terms of possible neurological injury, operative time, and potential morbidity. The authors reviewed the literature relating to these osteotomy methods. They also provided case illustrations and suggestions for their proper application.

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Single-Stage Thoracolumbar Vertebrectomy With Circumferential Reconstruction And Arthrodesis: Surgical Technique And Results In 15 Patients

Cited by 37 publications

References 23 publications

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

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

The Corpectomy Using Minimally Invasive Access in Thoracolumbar Fractures

Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review

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