En bloc video-assisted thoracoscopic vertebrectomy for a spinal tumour.

Abstract

Complex thoracic vertebral tumours remain a surgical challenge in terms of the surgical approach to ensure a complete en bloc vertebrectomy with healthy margins, along with optimal control of the thoracic structures next to the spine. A combined three-port left thoracoscopic posterior approach, with the patient placed in a prone position with selective double-lumen intubation, can be performed in patients with spinal tumours involving soft tissues, for direct access to the thoracic structures, even with T10-T11 vertebral tumours next to the diaphragm. The video thoracoscopic technique with an enhanced view of the posterior mediastinum permits progressive dissection of the descending aorta, oesophagus, azygos vein, thoracic ductus and diaphragmatic pillars from the vertebral body that is involved by the spinal tumour. The complete dissection of those structures from the spine provides a good surgical view of the contralateral pleural cavity to enable complete control of the tumoral mass. A complete en bloc vertebrectomy with spinal cord ligation is then completely and safely performed with Gigli saws above and under the tumour, respecting healthy tissue margins, under video thoracoscopic monitoring of the anterior structures. Finally, a spinal prosthesis is positioned through the posterior access and stabilized with thoracic and lumbar spinal arthrodesis.