290 A Rib-Sparing Unilateral Transpedicular Thoracic Corpectomy Using the Ultrasonic Bone Scalpel: A Novel Technique and Pictorial Guide

Abstract

INTRODUCTION: Posterior thoracic corpectomies typically require removal of the costotransverse articulation and some amount of the adjoining rib, an accompaniment that has been shown to result in significant post-operative morbidity. There are several well-described approaches to pathology of the thoracic spine, each with advantages, disadvantages, and inherent limitations. METHODS: The technique is demonstrated step-by-step in a videographic pictorial description of the procedure performed on both a molded plastic spine model and on a cadaveric specimen. A retrospective chart review was conducted on patients having undergone this thoracic corpectomy technique since its implementation at the senior author’s institution. Patient data, operative metrics, and outcomes were collected and analyzed. RESULTS: A total of 36 corpectomies were performed on 32 patients (mean age = 63 years). There were oncological (n = 22, 69%), degenerative/traumatic (n = 7, 22%), and infection (n = 3, 9%) indications. EBL averaged 853 cc for 30/32 cases. Operative time averaged 177.83 minutes. Length of stay averaged 6.47 days. One clinically inconsequential iatrogenic durotomy occurred. One patient had a surgical site infection three weeks later that required wound washout without hardware revision. CONCLUSIONS: Rib resection correlates with significant post-operative pain. This thoracic corpectomy technique mitigates morbidity by avoiding manipulation, destabilization, or resection of the rib, potentially permitting faster recovery and discharge. The technique is dependent on the UBS as it expediently creates a tailored window for an expandable corpectomy cage. A rib-sparing thoracic corpectomy can be effectively, efficiently, and safely performed using a combination of the UBS and an expandable cage during a single stage posterior-only unilateral transpedicular approach with which most spine surgeons are familiar.