title: Thoracic lateral extracavitary corpectomy for anterior column reconstruction with expandable and static titanium cages: clinical outcomes and surgical considerations in a consecutive case series.
abstract: OBJECTIVE
  Many surgical interventions have emerged as effective means of restoring mechanical stability of the anterior column of the spine. The lateral extracavitary approach (LECA) allows for broad visualization and circumferential reconstruction of the spinal column. However, early reports demonstrated significant complication rates, protracted operative times, and prolonged hospitalizations. More recent reports have highlighted concerns for subsidence, particularly with expandable cages. Our work seeks to describe a single-surgeon consecutive series of patients undergoing LECA for thoracic corpectomy. Specifically, the objective was to explore the surgical considerations, clinical and radiographic outcomes, and complication profile of this approach.
  
  
  METHODS
  A retrospective study examined data from 17 consecutive patients in whom single or multi-level corpectomy was performed via a LECA by a single surgeon. Vertebral body replacement was achieved with either a static or expandable titanium cage. The Karnofsky Performance Scale (KPS) was utilized to assess patient functional status before and after surgery. Radiographic outcomes, particularly footplate-to-body ratio and subsidence, were assessed on CT imaging at 6 weeks after surgery and at follow-up of at least 6 months.
  
  
  RESULTS
  The majority of patients had post-operative KPS scores consistent with functional independence (≥70, 12/17 patients, 71%). Fourteen patients had improved or maintained function by last follow-up. In both groups, all patients had a favorable footplate-to-body ratio, and rates of subsidence were similar at both time points. Notably, the overall complication rate (24%) was significantly lower than that published in the literature, and no patient suffered a pneumothorax that required placement of a thoracostomy tube.
  
  
  CONCLUSIONS
  The LECA approach for anterior column reconstruction with static or expandable cages is an important surgical consideration with favorable surgical parameters and complication rates. Further, use of expandable cages may allow for reconstruction over a larger segment without increased risk of subsidence.
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, 1365B Clifton Road NE, Atlanta 30322, USA; Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta 30322, USA. Electronic address: cmholland@emory.edu.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Holland
authors.affiliation: Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta 30322, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Bass
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, 1365B Clifton Road NE, Atlanta 30322, USA; Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta 30322, USA.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Gary
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, 1365B Clifton Road NE, Atlanta 30322, USA; Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta 30322, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Howard
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, 1365B Clifton Road NE, Atlanta 30322, USA; Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta 30322, USA; Emory Orthopaedics and Spine Center, 59 Executive Park South, Suite 3000, Atlanta 30329, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Refai
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D014025:Titanium / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D014025:Titanium
keywords: Corpectomy; Expandable cage; Lateral extracavitary; Spinal fusion; Static cage; Thoracic