Thoracolumbar Corpectomy Research Articles

Minimally Invasive Thoracolumbar Corpectomy and Percutaneous Pedicle Screw Fixation with Computer-Assisted Rod-Bending System in Single Lateral Position: Technical Note

Thoracolumbar corpectomy and percutaneous pedicle screw (PPS) fixation is becoming the standard method for correcting and stabilizing malalignment of spine, as is often seen in osteoporotic vertebral fracture. Nowadays, this procedure can be performed in a single lateral position with navigation. For an osteoporotic spine, accurate rod bending is necessary to prevent screw back-out. We describe a new technique using the spinal rod-bending system in a single lateral position. A 71-year-old woman presented with severe back pain and impending paraplegia secondary to L1 osteoporotic vertebral fracture. We performed minimally invasive L1 corpectomy with an expandable vertebral cage and short-segment PPS with computer-assisted rod bending in a single lateral position under navigation guidance. The patient was successfully treated with surgery, and her low back pain improved. Her clinical outcomes improved; the Oswestry Disability Index went from 54% to 26%, and her low back pain visual analog scale score went from 78 mm to 19 mm at the 2-year final follow-up. Minimally invasive surgery thoracolumbar corpectomy using a computer-assisted spinal rod-bending system is a valuable technique to reduce screw back-out for osteoporotic vertebrae. With this new technique, the rod bending becomes easy, even for long PPS fusion with the severe osteoporotic or deformity patient in a single lateral position.

Minimally invasive thoracolumbar corpectomy with navigated expandable vertebral cage: A technical note

Minimally invasive thoracolumbar corpectomy with navigated expandable vertebral cage: A technical note

A Comparison of Surgical Outcomes Between Minimally Invasive and Open Thoracolumbar Corpectomy.

Minimally invasive (MIS) techniques have gained considerable attention for the management of degenerative spinal pathologies. However, few studies have compared the outcomes between MIS and open thoracolumbar corpectomies. The purpose of this study was to compare perioperative variables between MIS and open thoracolumbar corpectomy. Retrospective review of 33 patients who underwent either an MIS or open thoracolumbar corpectomy by a single surgeon between 2005 and 2012 was performed. Patients were separated into anterior-posterior MIS (MIS AP), anterior-posterior open (AP), and posterior open (P) cohorts. Postoperative narcotic use was converted to oral morphine equivalents (OMEs). Demographics, comorbidity, perioperative variables, complications, and computed tomographic analyses were assessed. Fisher exact test was performed for categorical variables and Student t test for continuous variables. A P value of ≤ .05 denoted statistical significance. Thirty-three patients underwent an MIS AP, AP, or P thoracolumbar corpectomy (39.4% vs 15.2% vs 45.5%, respectively). MIS AP patients were younger with a lower comorbidity burden than either open cohorts. In addition, MIS AP patients demonstrated a decreased procedural time, lower blood loss, and shorter hospitalization than either open cohorts. MIS AP patients required less units of transfusion than P and AP patients while demonstrating lower postoperative narcotics consumption and reoperations rates than open AP patients. Surgical site infection rates, body mass index, intraoperative fluid requirements, and complication rates were similar between cohorts. All patients demonstrated successful arthrodesis at 1 year based upon computed tomography. MIS AP thoracolumbar corpectomy patients incurred decreased procedural times, shorter hospitalization, and lower blood loss compared with open patients. MIS AP patients demonstrated decreased postoperative narcotics consumption and reoperation rates compared with traditional AP patients. All patients demonstrated successful arthrodesis. The MIS approach to thoracolumbar corpectomies appears to be a safe and efficacious alternative when compared with traditional methods.

Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures.

The need for anterior column reconstruction after thoracolumbar burst fractures remains controversial. Here, the authors present their experience with minimally invasive lateral thoracolumbar corpectomies for traumatic fractures. Between 2012 and 2019, 59 patients with 65 thoracolumbar fractures underwent 65 minimally invasive lateral corpectomies (MIS group). This group was compared to 16 patients with single-level thoracolumbar fractures who had undergone open lateral corpectomies with the assistance of general surgery between 2007 and 2011 (open control group). Comparisons of the two groups were made with regard to operative time, estimated blood loss, time to ambulation, and fusion rates at 1 year postoperatively. The authors further analyzed the MIS group with regard to injury mechanism, fracture characteristics, neurological outcome, and complications. Patients in the MIS group had a significantly shorter mean operative time (228.3 ± 27.9 vs 255.6 ± 34.1 minutes, p = 0.001) and significantly shorter mean time to ambulation after surgery (1.8 ± 1.1 vs 5.0 ± 0.8 days, p < 0.001) than the open corpectomy group. Mean estimated blood loss did not differ significantly between the two groups, though the MIS group did trend toward a lower mean blood loss. There was no significant difference in fusion status at 1 year between the MIS and open groups; however, this comparison was limited by poor follow-up, with only 32 of 59 patients (54.2%) in the MIS group and 8 of 16 (50%) in the open group having available imaging at 1 year. Complications in the MIS group included 1 screw misplacement requiring revision, 2 postoperative femoral neuropathies (one of which improved), 1 return to surgery for inadequate posterior decompression, 4 pneumothoraces requiring chest tube placement, and 1 posterior wound infection. The rate of revision surgery for the failure of fusion in the MIS group was 1.7% (1 of 59 patients). The minimally invasive lateral thoracolumbar corpectomy approach for traumatic fractures appears to be relatively safe and may result in shorter operative times and quicker mobilization as compared to those with open techniques. This should be considered as a treatment option for thoracolumbar spine fractures.

Letter to the Editor Regarding “Minimally Invasive Thoracolumbar Corpectomy and Stabilization for Unstable Burst Fractures Using Intraoperative Computed Tomography and Computer-Assisted Spinal Navigation”

Letter to the Editor Regarding “Minimally Invasive Thoracolumbar Corpectomy and Stabilization for Unstable Burst Fractures Using Intraoperative Computed Tomography and Computer-Assisted Spinal Navigation”

Minimally Invasive Thoracolumbar Corpectomy and Stabilization for Unstable Burst Fractures Using Intraoperative Computed Tomography and Computer-Assisted Spinal Navigation

Minimally invasive surgery using a mini-open lateral retropleural or retroperitoneal approach for corpectomy is a well-described procedure for treating unstable thoracolumbar burst fractures. Most surgeons have incorporated fluoroscopy for localization and determination of hardware placement accuracy; however, the utility of computer-assisted image-guided spinal navigation has not been well described. We report a series of mini-open lateral approach thoracolumbar corpectomy cases using either fluoroscopy or intraoperative computed tomography (iCT) with computer-assisted navigation and discuss the technical nuances and advantages of using iCT with navigation versus fluoroscopy. A retrospective review and analysis was performed of the cases of 20 patients with thoracolumbar burst fractures surgically managed via mini-open lateral corpectomy with fluoroscopy (2013-2015) or iCT navigation (2015-2017). The surgical outcomes were evaluated by the estimated blood loss, operative time, hospital stay, and need for revision. The clinical outcomes were evaluated using the numerical rating scale pain score. Radiographic outcomes were assessed with follow-up CT scans. The results were statistically analyzed using the Wilcoxon-Mann-Whitney test. The mean follow-up period was 13.4 months for the fluoroscopy group and 14.7 months for the iCT group. No surgical complications developed and no revisions were required. No statistically significant differences were found between the groups in surgical or clinical outcomes. However, the radiation exposure to the surgeons was significantly less with the iCT group (P < 0.003). The use of iCT with spinal navigation for mini-open lateral corpectomy for thoracolumbar burst fractures yields perioperative and clinical outcomes comparable to those using traditional fluoroscopy, with decreased radiation exposure to surgeons.

Acute and Hyper-acute Thoracolumbar Corpectomy for Traumatic Burst Fractures Using a Mini-open Lateral Approach

Retrospective chart review. The purpose of this study was to examine the feasibility of acute (<24 hours) and hyperacute (<8 hours) treatment of thoracolumbar burst fractures to maintain or improve spinal injury scores. Historically, treatment of spinal burst fractures within 24 hours from injury was considered an "acute" treatment timeframe. Patient polytrauma triage, multiple surgical specialty, and hospital resource coordination affect time to treatment. The mini-open lateral approach for thoracolumbar corpectomy obviates the need for an approach surgeon, which may allow for early surgical intervention. Sixteen patients treated within 24 hours with a mini-open lateral corpectomy for traumatic spinal pathology were reviewed for preoperative, perioperative, and postoperative data. Neurologic status was assessed using American Spinal Injury Association (ASIA) scores. Fractures occurred primarily from L1 to L3. Wide-footprint expandable titanium devices were used in 75% of patients. All patients received supplemental fixation. Average time from injury to admission to the hospital (emergency room [ER]) was 1.8 hours, with an average time from the ER to operating room (OR) of 8.2 hours and an average OR time of 2.7 hours. Eight patients required ≤8 hours from injury event to surgical initiation, whereas seven patients required between 8 and 24 hours for surgery initiation (one patient with incomplete surgical timing record). Blood loss averaged 646 mL without intraoperative complication. One perioperative complication occurred and one patient developed an asymptomatic inferior vertebral body fracture. Length of hospital stay averaged 6 days. At last follow-up, nearly all patients experienced full or near-complete neurologic recovery with at least one ASIA grade improvement seen in 73% and 20% of patients improving two grades or more. These results suggest that mini-open lateral approaches allow immediate decompression through hyperacute (<8 hours) treatment of spinal burst fractures in eligible patients. Additionally, low perioperative and postoperative morbidity allows for hastened recovery. 4.

Commentary of Acute and Hyperacute Thoracolumbar Corpectomy for Traumatic Burst Fractures Using a Mini-open Lateral Approach.

Commentary of Acute and Hyperacute Thoracolumbar Corpectomy for Traumatic Burst Fractures Using a Mini-open Lateral Approach.

Mini-Open Thoracolumbar Corpectomy: Perioperative Outcomes and Hospital Cost Analysis Compared with Open Corpectomy

Standard open surgical management of thoracolumbar infection, trauma, and tumor is associated with significant morbidity. We compared perioperative and immediate postoperative morbidity of open and mini-open thoracolumbar corpectomy techniques including direct hospital costs. We retrospectively reviewed medical records of all patients who underwent open or mini-open corpectomy. Demographics (age, sex, body mass index, primary diagnosis), operative data (length of surgery, estimated blood loss, blood transfusion), surgical level, preoperative and postoperative neurologic status (using American Spinal Injury Association Impairment Scale), immediate perioperative complications (within 30 days postoperatively), overall length of stay from admission, length of stay from surgery, and total direct hospital costs were tabulated and analyzed. The study included 43 patients, 20 (46.51%) undergoing open corpectomy and 23 (53.48%) undergoing mini-open corpectomy. Clinical and statistically significant findings in favor of mini-open corpectomy included lower estimated blood loss (1305 mL vs. 560 mL, P= 0.0072), less blood transfusion (241 mL vs. 667 mL, P= 0.029), shorter overall length of stay (7.2 days vs. 12.2 days, P= 0.047), and shorter surgery time (376 minutes vs. 295 minutes, P=0.035) as well as lower total direct hospital cost ($34,373 vs. $45,376, P= 0.044). There was no statistically significant difference in postoperative complications between the 2 groups (medical complications 5% vs. 4.3%, P= 0.891; surgical complications 5% vs. 8.69%, P= 0.534). Mini-open TL corpectomy is a safe, cost-effective, clinically effective, and less morbid alternative to standard open thoracotomy surgical techniques.

Preoperative Embolization in Spinal Tumour Surgery

Introduction Preoperative embolization has been shown to be effective in reducing intraoperative blood loss during metastatic spinal tumor surgery. However, the majority of studies investigating preoperative embolization for spinal metastases have preferentially selectedsecondaries fromrenal and thyroid as these are highly vascularized tumors. There is paucity of literature describing utility of embolization in other tumors. We aimed to determine the effect of preoperative embolization on intraoperative blood loss indifferent spinal tumors by type of surgical approaches. Materials and Methods We retrospectively evaluated 221 patients undergoing surgery for primary or metastatic spine tumors. Patients were analyzed for the effect of embolization agents, extent, level of embolization and timing between embolization &amp; surgery, on estimated blood loss. Estimated blood loss and transfusion requirements were compared between embolized and non-embolized cases for different types of spinal tumor (metastatic lung, breast, renal, hepatocellular, thyroid, other epithelial tumors, myeloma/lymphoma and primary spine tumors) and surgical approaches (Type I: Cervical spine surgery either anterior and/or posterior stabilization with or without corpectomy, Type II: Thoracolumbar posterior instrumentation and decompression, and Type III: Thoracolumbar corpectomy). Results Preoperative embolization was performed in 48 patients. Hypervascular angiographic appearance was found in 22 (46%) and capillary blush in 26 (54%) embolized patients. Total embolization (&gt;80% reduction of tumor blush) was achievable in more than half of the embolized patients (61%), and less amount of blood loss was observed in these patients (median blood loss = 900ml) compared with those who achieved partial (&lt;50%) and subtotal (50–90%) embolization (1600ml and 1350ml respectively). Blood loss was also lower in those who achieved proximal embolization and those who underwent surgery between 13–24 hours after embolization. When stratified by type of tumor and surgical approaches, blood loss and transfusion requirement were lower in embolized cases of spinal secondaries from HCC &amp; thyroid; and primary spine tumors. In multivariate linear regression, after adjusting for tumor type, type of surgical procedure, invasiveness index, preoperative haemoglobin and operative time, there were no significant differences in the blood loss as well as blood transfusion units between embolized and non-embolized groups. Conclusions Success of embolization in reducing blood loss depends on the extent of embolization, which should be total; and time interval between embolization and index surgery, which should be within 13–24 hours. Preoperative embolization is a useful modality in decreasing intraoperative blood loss in cases of spinal metastases from HCC, thyroid and primary spine tumors.

Use of Intramedullary K-Wire to Enhance Fibular Graft Placement in 4-Level Thoracolumbar Corpectomy for Pott Disease: Case Report and Review of Literature

Reports of tuberculosis involving ≥4 contiguous spinal levels are rare. Surgery is often required in this population for neurological decompression and stabilization. These patients appear to be particularly predisposed to complications that include incomplete recovery of neurological function after decompression as well as post-treatment kyphosis. In settings with limited available instrumentation, reconstruction of the anterior column can be challenging. A 35-year-old woman presented with back pain, progressive weakness in her bilateral lower extremities, and inability to walk for 2 months. Imaging demonstrated anterior destruction of T10, T11, T12, and L1 with severe retropulsion and cord impingement at T11-T12. The patient was taken for anterolateral corpectomies of T10-L1 with decompression of the thoracic spinal cord and fibular strut autograft placement followed by a T8 to L3 posterior spinal fusion. An intramedullary Kirschner-wire (K-wire) was placed during the anterolateral procedure to enhance fibular graft placement and prevent dislodgement before definitive posterior fusion. At follow-up five-and-a-half months after the operation, the patient had recovered full strength and was ambulating without difficulty. Imaging at this time demonstrated stable restoration of alignment without graft dislodgement. Intramedullary fibular K-wire placement in this procedure helped to optimize anterior column reconstruction. The principles used in this report may prove beneficial to surgeons in developing countries who encounter pathology of this extent.

Blood Loss and Transfusion Requirements in Metastatic Spinal Tumor Surgery: Evaluation of Influencing Factors.

Metastatic spine tumor surgery (MSTS) can be associated with significant blood loss. Previous studies did not provide comprehensive data on blood loss in MSTS. Thorough study elaborating the blood loss, transfusion requirement, and their influencing factors is required. This study aimed to investigate the estimated blood loss and transfusion requirements associated with various surgical approaches and surgically managed vertebral levels for spinal metastases from different primary tumors. The study retrospectively evaluated 243 patients who underwent surgery for metastatic spine tumors at the authors' institution between 2005 and 2014. Estimated intraoperative blood loss and transfusion requirement were assessed for different primary tumors including lung, breast, prostate, gastrointestinal, renal, liver, thyroid, myeloma/lymphoma, and others; types of surgical procedure (cervical corpectomy±stabilization, thoracolumbar posterior decompression±instrumentation, thoracolumbar corpectomy, minimally invasive surgery); and levels of instrumentation and decompression. Multivariate linear regression was attempted to investigate the factors influencing blood loss and transfusion requirements. The mean blood loss was 870±720ml, and the average blood transfusion was 1.5±1.9 U. The mean blood loss was 1103ml for patients who received blood transfusion and 597ml for those who did not. Multivariate analysis showed that the significant factors influencing blood loss were primary tumor, type of surgery, and prolonged operative time. The influencing factors for blood transfusion were primary tumor, type of surgery, preoperative hemoglobin, and prolonged operative time. Significant variations in blood loss and transfusion requirement were based on primary tumor of spinal metastases, surgical approaches, and operative time. These findings will help clinicians in preoperative planning to address the problem of blood loss during MSTS.

Efficacy of Titanium Mesh Cages for Anterior Column Reconstruction after Thoracolumbar Corpectomy.

Study DesignThis retrospective study was conducted to determine the safety and efficacy of titanium cage reconstruction and anterior plating after thoracolumbar corpectomy.PurposeTo study the clinical and radiological outcome of anterior column reconstruction after thoracolumbar corpectomy.Overview of LiteratureAnterior column reconstruction aims to optimize neural decompression with adequate stabilization.MethodsA series of 16 patients underwent reconstruction after thoracolumbar corpectomy to treat injury due to trauma (n=10), tuberculosis (n=3), and tumor (n=3). The average duration of follow-up was 18 months (range, 8–58 months). The degree of kyphosis, construct height, and the subsidence of the cage in relation to the vertebral endplates were measured. The approach was thoracoabdominal in 10 cases and retroperitoneal in 6 cases.ResultsFour patients were neurologically intact with Frankel grade E on admission, and all remained intact postoperatively. Of the 6 patients with Frankel grade D, all fully recovered full motor and sensory functions. Of the 6 patients with Frankel grade C, three improved one grade and the other three improved two grades. The mean height of the vertebra before surgery was 41 mm and the mean construct height immediately after surgery and at follow-up was 47 mm and 44 mm, respectively. Solid fusion was observed in all patients. The sagittal alignment of the fractured segment was restored immediately after surgery as a significant decrease in the local kyphotic angle.ConclusionsAnterior instrumentation is an effective and safe treatment for thoracolumbar instability with satisfactory clinical and radiological outcomes.

Corpectomia toracolombar lateral parcial em cães e gatos – revisão

Intervertebral disk disease is one of the most common neurological conditions in dogs; thoracolumbar disk is a usual cause of neurological dysfunction in this species. Several clinical and surgical treatments have been described, ranging from acupuncture and confinement to the use of anti-inflammatory, analgesic and muscle relaxant drugs, as well as the employment of varied surgical decompression techniques. The partial thoracolumbar lateral corpectomy is an alternative and effective surgical technique to treat chronic and acute thoracolumbar disk disease. It allows adequate access to the floor of the spinal canal for removal of disc material with minimal handling of the spinal cord, allowing wide and effective decompression. This review deals with anatomical, surgical and biomechanical aspects of this technique, and discusses its indications, advantages and disadvantages.

A Comparison of Surgical Outcomes between Minimally Invasive and Open Thoracolumbar Corpectomy: A Minimum of Two-Year Follow-Up

Few studies have assessed the differences in surgical outcomes between minimally invasive (MIS) and open thoracolumbar corpectomies for oncologic, infectious and traumatic conditions.

The Impact of Preoperative Angiographic Identification of the Artery of Adamkiewicz on Surgical Decision Making in Patients Undergoing Thoracolumbar Corpectomy.

Retrospective study. To investigate the impact of spinal angiography on selection of surgical side in patients undergoing thoracolumbar corpectomy. The artery of Adamkiewicz provides the major blood supply to the thoracolumbar spinal cord. Its location makes it vulnerable to injury during surgical procedures. Preoperative diagnostic spinal angiography is often used to determine the level and lateralization of the artery. Data were gathered regarding level and laterality of the Adamkiewicz artery in 34 patients who underwent lateral extracavitary approaches to the thoracolumbar spine, preceded by diagnostic spinal angiography for localization of that artery. Two experienced spine surgeons were retrospectively polled regarding ideal side of approach for each case. This was compared with the actual side that was selected after angiographic localization. The artery was successfully identified in 71% of patients. The artery was most commonly located on the left side (83%) between T9 and L1 (83%). Diagnostic angiography seemed to have influenced surgical decision making in 54% of cases. In 21% of patients, there was no need to alter the side of approach. In the remaining 25%, the surgical plan was not altered on the basis of angiographic data, presumably due to anatomic limitations. No angiography- or surgery-related complications occurred in any of the patients. Preoperative spinal angiography seems to impact surgical decision making with regard to alteration of the side of approach in patients undergoing thoracolumbar corpectomy via lateral extracavitary approaches. 4.

Blood Loss and Transfusion Requirement in Spine Tumor Surgery: 10 Years' Experience

Background Surgical management of spinal tumors is an essential component of the comprehensive care of patients with cancer. It is often of a prolonged duration, which makes the anticipation and replenishment of blood lost during the surgery quite significant. Till date, there has been no consensus regarding the typical volume of blood loss during spine tumor surgeries. As a result, blood products are often ordered preoperatively in excessive quantities because of the nonexistence of specific blood ordering guidelines. This study was conducted to investigate the extent of blood loss and transfusion requirement associated with various surgical approaches and vertebral levels for different types of spinal tumors so that it would facilitate preoperative planning and management of blood transfusion. Patients and Methods We retrospectively analyzed the patients who underwent spine tumor surgery at our institution from 2005 to 2014. Types of primary tumor (I: highly vascularized tumor, II: moderately vascularized tumor, III: hematological tumor, and IV: primary bone tumor), types of surgery (1: cervical corpectomy and stabilization; 2: thoracolumbar posterior decompression and instrumentation; 3: thoracolumbar corpectomy; and 4: minimally invasive surgery), level of instrumentation (&lt; 6, 6–, and &gt; 9 levels), and decompression (0, 1–2, 3–4, and &gt; 4) on the influence of blood loss were analyzed. The amount of blood transfused was also assessed. Generalized linear model was used for analysis. Results A total of 260 patients were evaluated. Mean blood loss was 660 mL (range, 20–6,000 mL). In multivariate analysis, there were statistically significant differences in the amount of blood loss in different subgroups of tumor types, type of surgical approaches, and groups of level of decompression. Multivariate analysis revealed that intraoperative blood loss rose significantly in proportion to increasing levels of decompression as well as instrumentation. Compared with highly vascularized tumor group, there was a significant reduction in mean blood loss in moderately vascularized and hematological tumor groups (−617 and −436 mL, respectively). Compared with open cervical approach, there was a significant reduction in mean blood loss in minimally invasive surgery (−614 mL) and a borderline increase in thoracolumbar corpectomy surgery (319 mL). Significant association between blood loss and blood transfusion were also observed. The mean blood loss of patients who received blood transfusion was 1,166 mL and that of patients who did not receive was 526 mL. Univariate analysis revealed that type of primary tumor and type of surgical approach were significant predictors of blood transfusion requirement. Multivariate analysis revealed that the amount of blood transfusion requirement was significantly lower in moderately vascularized tumors (1.2 units less) but significantly higher in primary bone tumors (1.8 units more) as compared with highly vascularized tumors. Minimally invasive surgical approach significantly reduced blood transfusion requirement by 1.3 units as compared with open cervical approach. Conclusions There was a significant variation in the amount of blood loss based on primary tumors and types of surgery. This study would help in preoperative planning to address the significant problem of blood loss during various spine tumor surgeries.

Range of motion after thoracolumbar corpectomy: evaluation of analogous constructs with a novel low-profile anterior dual-rod system and a traditional dual-rod system

An in vitro biomechanical study. To compare the biomechanical stability of traditional and low-profile thorocolumbar anterior instrumentation after a corpectomy with cross-connectors. Dual-rod anterior thoracolumbar lateral plates (ATLP) have been used clinically to stabilize the thorocolumbar spine. The stability of a low-profile dual-rod system (LP DRS) and a traditional dual-rod system (DRS) was compared using a calf spine model. Two groups of seven specimens were tested intact and then in the following order: (1) ATLP with two cross-connectors and spacer; (2) ATLP with one cross-connector and spacer; (3) ATLP with spacer. Data were normalized to intact (100%) and statistical analysis was used to determine between-group significances. Both constructs reduced motion compared to intact in flexion-extension and lateral bending. Axial rotation motion became unstable after the corpectomy and motion was greater than intact, even with two cross-connectors with both systems. Relative to their respective intact groups, LP DRS significantly reduced motion compared to analogous DRS in flexion-extension. The addition of cross-connectors reduced motion in all loading modes. The LP DRS provides 7.5mm of reduced height with similar biomechanical performance. The reduced height may be beneficiary by reduced irritation and impingement on adjacent structures.

Anterior approach for surgery of thoracolumbar spine: surgical outcomes of series of one self-trained neurosurgeon

Summary Purpose Most neurosurgeons in Taiwan are not trained formally to perform anterior approaches for thoracolumbar corpectomies in the treatment of thoracolumbar lesions during their residencies. Often, such procedures are conducted with the assistance of “access surgeons”. Materials and methods Prior to performing anterior thoracolumbar corpectomies in clinical cases, one senior neurosurgeon, who was not trained in the anterior approaches, acquired the relevant skills from cooperating access surgeons, by attending a workshop, and by practicing on cadavers. Between December 2006 and March 2011, 18 consecutive patients underwent surgeries involving the anterior approach to thoracolumbar lesions. Patients operated on by the self-trained neurosurgeon were included in Group 1, and those operated on by neurosurgeons assisted by access surgeons were included in Group 2. Operative time, blood loss, complications, and neurologic outcomes were compared between the two groups. Results Group 1 consisted of 10 patients (4 men), with a mean age of 62.5 years, and Group 2 of eight patients (5 men), with a mean age of 58.3 years. The median follow-up periods for both groups were 15.5 and 17 months, respectively. Operative time, blood loss, rate of complications, and neurologic outcomes were comparable between the two groups. Conclusion Through observation, by attending workshops, and by practicing the anterior approach on cadavers, the self-trained neurosurgeon became competent in the anterior thoracolumbar corpectomy and achieved comparable results to surgeons who were assisted by access surgeons in terms of operative time, blood loss, complications, and neurologic outcomes.

Anterior Column Reconstruction Using Titanium Mesh Cages after Thoracolumbar Corpectomy: Clinical and Radiological outcome

Background Data: The optimal treatment of unstable thoracolumbar spine due to trauma, tumors, and tuberculous spondylitis remains controversial. Treatment goals of thoracolumbar corpectomy are: to prevent neurological deterioration; enhance neurological recovery; stabilization, and to prevent late pain and deformity.Purpose: This retrospective study was conducted to determine the safety and efficacy of stabilization using titanium mesh cage reconstruction filled with autogenous bone graft and anterior plating after thoracolumbar corpectomy due to trauma, tumors or tuberculous spondylitis. Study Design: A retrospective clinical case study. Patients and Methods: A series of patients underwent reconstruction of the anterior column after thoracolumbar corpectomy between June 2006 and June 2011 were reviewed. Sixteen patients underwent reconstruction using titanium mesh cages, and retrospectively analyzed data from the medical records and radiographs including immediate postoperative and latest follow up. The etiology due to trauma in ten cases, tuberculosis in three cases, metastasis in two cases and myeloma in one case. An average duration of follow up was 18 months [ 8-58 months ], single level reconstruction done in trauma and tumor cases, two level corpectomy done in tuberculous spondylitis cases. The degree of kyphosis, construct height and the subsidence of the cage in relation to the vertebral endplates were measured preoperatively, early post operative, and at the latest follow up. The surgical approach was thoracoabdominal in 10 cases and retroperitoneal in 6 cases. Results: Neurological recovery in our study; 4 patients were neurologically intact, Frankel grade E on admission , and all of them remains intact postoperatively. Of the 6 patients with Frankel D on admission, all had recovered full motor and sensoryfunction. Of the 6 patients with Frankel C on admission, three improved one grade, the other three improved two grades. The mean construct height of the involved vertebrae before surgery was 41 mm and the mean construct height immediateafter surgery and at follow up were 47 and 44 mm respectively. Solid fusion was observed in all patients, there were no hardware failure. The sagittal alignment of the fractured segment was satisfactorily restored immediately after surgery as a significant decrease in the local kyphotic angle. Conclusion: Anterior instrumentation is an effective and safe treatment for thoracolumbar instability by demonstaring satisfactory clinical and radiological outcomes. (2012ESJ028)