title: Minimally invasive lateral retropleural thoracolumbar approach: cadaveric feasibility study and report of 4 clinical cases.
abstract: BACKGROUND
  Traditional anterior and posterior approaches to the thoracolumbar spine are associated with significant morbidity. In an effort to eliminate these drawbacks, minimally invasive retropleural approaches have been developed.
  
  
  OBJECTIVE
  To demonstrate the feasibility and clinical experience of a minimally invasive lateral retropleural approach to the thoracolumbar spine.
  
  
  METHODS
  Seven cadaveric dissections were performed in 7 fresh specimens to determine the feasibility of the technique. In each specimen, the lateral aspect of the vertebral body was accessed retropleurally, and a corpectomy was performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the extent of decompression. As an adjunct, 3 clinical cases of thoracic fractures and 1 neurofibroma were treated with this minimally invasive approach. Operative results, complications, and early outcomes were assessed.
  
  
  RESULTS
  In the cadaveric study, adequate exposure was obtained to perform a lateral corpectomy and to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases without conversion to conventional approaches. A pleural tear was noted in the first clinical case, and a chest tube was placed without any long-term sequelae.
  
  
  CONCLUSIONS
  Our early experience suggests that the minimally invasive lateral retropleural approach allows adequate vertebrectomy and canal decompression without the tissue disruption associated with posterolateral approaches. This approach may improve the complication rates that accompany open or endoscopic approaches for thoracolumbar corpectomies.
authors.affiliation: Department of Neurological Surgery, University of South Florida, Tampa, Florida, USA. juansuribe@gmail.com
authors.forename: Juan S
authors.initials: JS
authors.lastname: Uribe
authors.forename: Elias
authors.initials: E
authors.lastname: Dakwar
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Cardona
authors.forename: Fernando L
authors.initials: FL
authors.lastname: Vale
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery; D002102:Cadaver; D005471:Fluoroscopy; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome