Minimally invasive posterolateral thoracic corpectomy: cadaveric feasibility study and report of four clinical cases.
OBJECTIVE
To demonstrate the feasibility of and initial clinical experience with a novel minimally invasive posterolateral thoracic corpectomy technique.


METHODS
Seven procedures were performed on 6 cadavers to determine the feasibility of thoracic corpectomy using a minimally invasive approach. The posterolateral thoracic corpectomies were performed with expandable 22 mm diameter tubular retractor paramedian incisions. The posterolateral aspects of the vertebral bodies were accessed extrapleurally, and complete corpectomies were performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the degree of decompression. In addition, 2 clinical cases of T6 burst fracture, 1 T4-T5 plasmacytoma, and 1 T12 colon cancer metastasis were treated using this minimally invasive approach.


RESULTS
In the cadaveric study, an average of 93% of the ventral canal and 80% of the corresponding vertebral body were removed. The pleura and intrathoracic contents were not violated. Adequate exposure was obtained to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases using a minimally invasive technique, and the patients demonstrated good outcomes.


CONCLUSIONS
Based on this study, minimally invasive posterolateral thoracic corpectomy safely and successfully allows complete spinal canal decompression without the tissue disruption associated with open thoracotomy. This approach may improve the complication rates that accompany open or even thoracoscopic approaches for thoracic corpectomy and may even allow surgical intervention in patients with significant comorbidities.
Kim
Dae-Hyun
DH
Department of Neurosurgery, Catholic University of Daegu, Daegu, South Korea.
O'Toole
John E
JE
Ogden
Alfred T
AT
Eichholz
Kurt M
KM
Song
John
J
Christie
Sean D
SD
Fessler
Richard G
RG
D000328:Adult; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D013118:Spinal Cord Diseases / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult