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Thoracic Corpectomy: Indications and Techniques

  • Steven Spitz
  • Anthony Conte
Chapter

Abstract

A spine surgeon must contemplate multiple factors, including a patient’s overall health and functional status, pathology, surgical goals, levels involved, and one’s own comfort level before undertaking a thoracic corpectomy. A variety of approaches have been developed over the last several decades to maximize access to and minimize manipulation of the thoracic spinal cord.

Keywords

Thoracic vertebral body resection Reconstruction Corpectomy Osteomyelitis Erosive discitis Epidural abscesses Transpedicular approach Costotransversectomy Transthoracic Mini-open Grafting 

References

  1. 1.
    Bilsky M, Boland P, Lis E, Raizer J, Healey J. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine. 2000;25(17):2240–50.CrossRefGoogle Scholar
  2. 2.
    Chandra SP, Ramdurg SR, Kurwale N, Chauhan AC, Ansari A, Garg A, Sarkar C, Sharma BS. Extended costotransversectomy to achieve circumferential fusion for pathologies causing thoracic instability. Spine J. 2014;14:2094–101.CrossRefGoogle Scholar
  3. 3.
    Chou D, Wang V. Trap-Door Rib-Head osteotomies for posterior placement of expandable cages after transpedicular corpectomy: an alternative to lateral extracavitary and costotransversectomy approaches. J Neurosurg Spine. 2009;10:40–5.CrossRefGoogle Scholar
  4. 4.
    Foreman P, Naftel R, Moore T, Hadley M. The lateral extracavitary approach to the thoracolumbar spine: a case series and systematic review. J Neurosurg Spine. 2016;24:570–9.CrossRefGoogle Scholar
  5. 5.
    Hartmann S, Wipplinger C, Tschugg A, Kavakebi P, Orley A, Girod PP, Thome C. Thoracic corpectomy for neoplastic vertebral bodies using a navigated lateral extracavitary approach-A single-center consecutive case series: techniques and analysis. Neurosurg Rev. 2017;41:575.  https://doi.org/10.1007/s10143-017-0895-z.CrossRefPubMedGoogle Scholar
  6. 6.
    Holland C, Bass D, Gary M, Howard B, Refai D. Thoracic lateral extracavitary corpectomy for anterior column reconstruction with expandable and static titanium cages: clinical outcomes and surgical considerations in a consecutive case series. Clin Neuro Neurosurg. 2015;129:37–43.CrossRefGoogle Scholar
  7. 7.
    Lau D, Chou D. Posterior Thoracic Corpectomy with Cage Reconstruction for Metastatic Spinal Tumors: Comparing the Mini-Open Approach to the Open Approach. J Neurosurg Spine. 2015;23:217–27.CrossRefGoogle Scholar
  8. 8.
    Lu D, Lau D, Lee J, Chou D. The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies. J Neurosurg Spine. 2010;12:583–91.CrossRefGoogle Scholar
  9. 9.
    Park M, Deukmedjian A, Uribe J. Minimally invasive anterolateral corpectomy for spinal tumors. Neurosurg Clin N Am. 2014;25:317–25.CrossRefGoogle Scholar
  10. 10.
    Schuschert M, McCormick K, Abbas G, Pennathur A, Landreneau J, Landreneau J, Pitanga A, Gomes J, Franca F, El-Kadi M, Peitzman A, Ferson P, Luketich J, Landreneau R. Anterior thoracic surgical approaches in the treatment of spinal infections and neoplasms. Ann Thorac Surg. 2014;97:1750–7.CrossRefGoogle Scholar
  11. 11.
    Yen CP, Uribe J. Mini-open lateral retropleural approach for symptomatic thoracic disc herniation. Clin Spine Surg. 2017;00:00.Google Scholar
  12. 12.
    Adkins D, Sandhu F, Voyadzis JM. Minimally invasive lateral approach to the thoracolumbar junction for corpectomy. J Clin Neurosci. 2013;20:1289–94.CrossRefGoogle Scholar
  13. 13.
    Ahmadian A, Uribe J. Mini-open lateral retropleural thoracic corpectomy for osteomyelitis. Neurosurg Focus. 2013;35:17.CrossRefGoogle Scholar
  14. 14.
    Moran C, Ali Z, McEvoy L, Bolger C. Mini-open retropleural transthoracic approach for the treatment of giant thoracic disc herniation. Spine. 2012;37(17):1079–84.CrossRefGoogle Scholar
  15. 15.
    Shawky A, Al-Sabrout AAR, El-Meshtawy M, Hasan K, Boehm H. Thoracoscopically assisted corpectomy and percutaneous transpedicular instrumentation in management of burst thoracic and thoracolumbar fractures. Eur Spine J. 2013;22:2211–8.CrossRefGoogle Scholar
  16. 16.
    Sasanui M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine. 2008;34(1):33–40.CrossRefGoogle Scholar
  17. 17.
    Hofstetter C, Chou D, Newman B, Aryan H, Girardi F, Hartl R. Posterior approach for thoracolumbar corpectomies with expandable cage placement and circumferential arthrodesis: a multicenter case series of 67 patients. J Neurosurg Spine. 2011;14:388–97.CrossRefGoogle Scholar
  18. 18.
    Fang T, Dong J, Zhou X, McGuire R, Li X. Comparison of mini-open anterior corpectomy and posterior total en-bloc spondylectomy for solitary metastases of the thoracolumbar spine. J Neurosurg Spine. 2012;17:271–9.CrossRefGoogle Scholar
  19. 19.
    Lubelski D, Abdullah K, Mroz T, Shin J, Alvin M, Benzel E, Steinmetz M. Lateral extracavitary vs. costotransversectomy approaches to the thoracic spine: reflections on lessons learned. Neurosurgery. 2012;71:1096–102.CrossRefGoogle Scholar
  20. 20.
    Lau D, Song Y, Guan Z, Sullivan S, La Marca F, Park P. Perioperative characteristics, complications, and outcomes of single-level versus multilevel thoracic corpectomies via modified costotransversectomy approach. Spine. 2013;38:523–30.CrossRefGoogle Scholar
  21. 21.
    Lubelski D, Abdullah K, Steinmetz M, Masters F, Benzel E, Mroz T, Shin J. Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: review of techniques and complications. J Spinal Disord Tech. 2013;26:222–32.CrossRefGoogle Scholar
  22. 22.
    Gokaslan Z, York J, Walsh G, McCutcheon I, Lang F, Putnam J, Wildrick D, Swisher S, Abi-Said D, Sawaya R. Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg Spine. 1998;89:599–609.CrossRefGoogle Scholar
  23. 23.
    Pointillart V, Aurouer N, Gangnet N, Vital JM. Anterior Approach to the Cervicothoracic Junction Without Sternotomy: A Report of 37 Cases. Spine. 2007;32(25):2875–9.CrossRefGoogle Scholar
  24. 24.
    Kalra R, Schmidt M. Thoracoscopic Corpectomy and Reconstruction. In: Benzel’s Spine Surgery. 4th ed; 2016. p. 646–54.Google Scholar
  25. 25.
    Nacar OA, Ulu MO, Pekmezci M, Deviren V. Surgical Treatment of Thoracic Disc Disease Via Minimally Invasive Lateral Transthoracic Trans/Retropleural Approach: Analysis of 33 Patients. Neurosurg Rev. 2013;36:455–65.CrossRefGoogle Scholar
  26. 26.
    Petteys R, Sandhu F. Minimally invasive lateral retroperitoneal corpectomy for treatment of focal thoracolumbar kyphotic deformity: case report and review of the literature. J Neurol Surg. 2014;75:305–9.CrossRefGoogle Scholar
  27. 27.
    Lau D, Song Y, Guan Z, La Marca F, Park P. Radiologic outcomes of static vs expandable titanium cages after corpectomy: a retrospective cohort analysis of subsidence. Neurosurgery. 2012;72:529–39.CrossRefGoogle Scholar
  28. 28.
    Archavlis E, Papadopoulos N, Ulrich P. Corpectomy in destructive thoracolumbar spine disease: cost-effectiveness of three different techniques and implications for cost reduction of delivered care. Spine. 2015;40(7):433–8.CrossRefGoogle Scholar
  29. 29.
    Han S, Lau D, Lu D, Theodore P, Chou D. Anterior thoracolumbar corpectomies: approach morbidity with and without an access surgeon. Neurosurgery. 2010;68:1220–6.CrossRefGoogle Scholar
  30. 30.
    Jandial R, Kelly B, Chen MY. Posterior-Only Approach for Lumbar Vertebral Column Resection and Expandable Cage Reconstruction for Spinal Metastases. J Neurosurg Spine. 2013;19:27–33.CrossRefGoogle Scholar
  31. 31.
    Krisht K, Mumert M, Schmidt M. Management considerations and strategies to avoid complications associated with the thoracoscopic approach for corpectomy. J Neurosurg Spine. 2011;31(4):14.Google Scholar
  32. 32.
    Kim JH, Rhee J, Enyo Y, Hutton W, Kim SS. A Biomechanical Comparison of 360 Degree Stabilizations for Corpectomy and Total Spondylectomy: A Cadaveric Study in the Thoracolumbar Spine. J Ortho Surg Res. 2015;10:99.  https://doi.org/10.1186/s13018-015-0240-6.CrossRefGoogle Scholar
  33. 33.
    Shen F, Marks I, Shaffrey C, Ouellet J, Arlet V. The use of an expandable cage for corpectomy reconstruction of vertebral body tumors through a posterior extracavitary approach: a multicenter consecutive case series of prospectively followed patients. Spine J. 2008;8:329–39.CrossRefGoogle Scholar
  34. 34.
    Smith Z, Li Z, Chen NF, Raphael D, Khoo L. Minimally invasive lateral extracavitary corpectomy: cadaveric evaluation model and report of three clinical cases. J Neurosurg Spine. 2012;16:463–70.CrossRefGoogle Scholar
  35. 35.
    Viljoen S, Watson NAD, Grosland N, Torner J, Dalm B, Hitchon P. Biomechanical analysis of anterior versus posterior instrumentation following a thoracolumbar corpectomy. J Neurosurg Spine. 2014;21:577–81.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Steven Spitz
    • 1
  • Anthony Conte
    • 2
  1. 1.MedStar Southern Maryland HospitalClintonUSA
  2. 2.Department of NeurosurgeryMedStar Georgetown University HospitalWashington, DCUSA

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