Vertebral body replacement by posterior approach for metastatic disease in the thoracic spine--modified technique using an expandable cage.

Abstract

To describe the technique of all-posterior vertebral body replacement using an expandable cage and angled instruments. This method facilitates implant seating with limited posterior decompression useful in the setting of metastatic disease. Patients with metastatic disease of the thoracic spine with or without spinal cord compression. Patients with a limited life expectancy of less than 6 months. Multiple foci of metastatic disease in the spine. A hemilaminectomy was performed followed by nerve root sacrifice. The pleura was mobilized away from the vertebral body, after which decompression and tumor resection was performed from an all-posterior approach. An expandable vertebral body cage was inserted with a rotational manoeuvre and expanded in situ. The patient was mobilized on postoperative day 1. A chest X-ray is also recommended to exclude incidental pneumothorax. Four patients were operated by an all-posterior vertebral body replacement during a 6-month period. The average length of surgical procedure was 187 min (range 165-220 min). No patient required a transthoracic approach. There were no intra- or postoperative complications and all patients could be discharged to home self-ambulating.