Abstract
Background:The purpose of this study was to assess the feasibility of using dual expandable cages plus short segment posterior fixation for reconstruction of vertebral bodies following a mini-open transpedicular approach.Methods:A single posterior incision was used to perform a laminectomy of L2, a partial laminectomy of L1 and bilateral transpedicular approaches for a piecemeal vertebrectomy in a patient with spinal compression secondary to metastatic cancer. Subsequently, bilateral cages were placed through the transpedicular corridors and percutaneous pedicle screws were inserted a single level above and below the level of the vertebral column resection.Results:The bilateral transpedicular approach facilitated the use of a mini-open incision (6.0 cm) compared with the extensive dissection normally employed for a lateral extracavitary type approach in the lumbar region. The bilateral transpedicular approach at L2 allowed for a vertebrectomy and complete decompression of neurological elements. The use of expandable cages allowed the nerve roots to be preserved. Placement of the cages in the lateral position was straightforward despite minimal exposure. The reconstruction with double expandable cages appeared robust.Conclusions:In select patients requiring circumferential decompression of the lumbar spine, dual cage reconstruction decreases the technical difficulty of the operation and facilitates a mini-open approach. The durability of this construct will need biomechanical assessment and long-term clinical follow-up.
Highlights
The purpose of this study was to assess the feasibility of using dual expandable cages plus short segment posterior fixation for reconstruction of vertebral bodies following a mini-open transpedicular approach
The posterior only approaches for anterior vertebral pathology are being used more frequently due to advances in technique and instrumentation
In the thoracic spine, the classic lateral extracavitary approach provides a generous corridor for vertebral tumor resection and subsequent central cage placement once nerve roots are sacrificed.[3,4]
Summary
The purpose of this study was to assess the feasibility of using dual expandable cages plus short segment posterior fixation for reconstruction of vertebral bodies following a mini-open transpedicular approach. Our aim is not to supplant accepted techniques but to offer another option that may be favorable in certain situations
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