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

Abstract

Circumferential reconstruction and arthrodesis can be necessary after thoracolumbar vertebrectomy. The authors describe a technique for single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis. The surgical results using this technique are reviewed. Fifteen patients ranging from 14 to 75 years of age underwent single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis. The vertebrectomy was performed through a posterior midline approach. Anterior column reconstruction was performed with expandable or nonexpandable cages. Anterior and posterolateral arthrodeses used autograft. Posterior segmental instrumentation was used in all cases. Fifteen procedures have been performed to date, 4 for tumor and 11 for fracture. The range of treated levels was T4 to L2 (7 thoracic spine and 8 lumbar spine levels). One patient was incomplete preoperatively (Frankel Grade C) and improved to being intact postoperatively (Frankel Grade E), another improved from Frankel Grade C to Frankel Grade D. All other patients were neurologically unchanged postoperatively. Mean operative time was 4.0 hours. Average blood loss was 1100 ml. Average number of levels fused was 5.8 (range 4-9). There were four complications: one delayed transient neurological deficit after deformity correction, one infection, one postoperative myocardial infarction, and one hardware failure. All patients were treated and had a good recovery. The authors present a method for thoracolumbar vertebrectomy, circumferential reconstruction, and arthrodesis performed in a single stage, solely via a posterior approach. This is an alternative to anterior (i.e., thoracoabdominal and retroperitoneal) and lateral (i.e., lateral extracavitary) approaches that can be used for circumferential reconstruction and arthrodesis. Potential advantages and pitfalls are discussed.