A Modified Microsurgical Endoscopic-Assisted Transpedicular Corpectomy of the Thoracic Spine Based on Virtual 3-Dimensional Planning.
OBJECTIVE
The main difficulties of transpedicular corpectomies are lack of space for vertebral body replacement in the neighborhood of critical structures, the necessity for sacrifice of nerve roots in the thoracic spine. and the extent of hemorrhage due to venous epidural bleeding. We present a modified technique of transpedicular corpectomy by using an endoscopic-assisted microsurgical technique performed through a single posterior approach. A 3-dimensional (3D) preoperative reconstruction could be helpful in the planning for this complex anatomic region.


METHODS
Surface and volume 3D reconstruction were performed by Amira or the Dextroscope. The clinical experience of this study includes 7 cases, 2 with an unstable burst fracture and 5 with metastatic destructive vertebral body disease, all with significant retropulsion and obstruction of the spinal canal. We performed a comparison with a conventional cohort of transpedicular thoracic corpectomies.


RESULTS
Qualitative parameters of the 3D virtual reality planning included degree of bone removal and distance from critical structures such as myelon and implant diameter. Parameters were met in each case, with demonstration of optimal positioning of the implant without neurological complications. In all patients, the endoscope was a significant help in identifying the origins of active bleeding, residual tumor, extent of bone removal, facilitating cage insertion in a minimally invasive way, and helping to avoid root sacrifice on both sides.


CONCLUSIONS
Microsurgical endoscopic-assisted transpedicular corpectomy may prove valuable in enhancing the safety of corpectomy in destructive vertebral body disease. The 3D virtual anatomic model greatly facilitated the preoperative planning.
Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany. Electronic address: neurosurgery@t-online.de.
Eleftherios
E
Archavlis
Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany.
Eike
E
Schwandt
Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany.
Michael
M
Kosterhon
Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany.
Angelika
A
Gutenberg
Neurochirurgische Klinik und Ambulanz, Sana Klinikum Offenbach, Offenbach, Germany.
Peter
P
Ulrich
Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany.
Amr
A
Nimer
Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany.
Alf
A
Giese
Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany.
Sven Rainer
SR
Kantelhardt
D000368:Aged; D016063:Blood Loss, Surgical; D019299:Decompression, Surgical / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005598:Fractures, Spontaneous / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007403:Intervertebral Disc / Q000601:surgery; D055959:Intervertebral Disc Degeneration / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D061646:Operative Time; D010347:Patient Care Planning; D065289:Pedicle Screws; D013122:Spinal Diseases / Q000601:surgery*; D016103:Spinal Fractures / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
3D planning; Corpectomy; Endoscopic assisted; Thoracic spine; Transpedicular