Abstract:

Minimally invasive surgery (MIS) is a promising new tool in the treatment of a variety of spinal disorders. MIS laminectomy techniques provide an effective means of achieving lumbar decompression. MIS corpectomy techniques have not been described. If feasible, such a technique would be optimal in the treatment of spinal metastatic disease, where traditional open techniques can result in a significant burden to a compromised patient. In this study, we explored the feasibility of a dual-tube minimally invasive thoracic corpectomy approach in a cadaver model. A minimally invasive thoracolumbar costotransversectomy and corpectomy were perfumed in eight adult cadavers. A dual-tube technique was used to perform a costotransversectomy followed by a corpectomy on one side, and through the opposite tube a transpedicular approach on the contralateral side. Pre- and postoperative CT scans of all cadavers were obtained to measure the cross-sectional area of the vertebral bodies in each specimen via a CT workstation. Reconstruction of the anterior column was attempted in some cadavers using polymethylmethacrylate (PMMA) cement. A successful costotransversectomy and corpectomy were completed in each cadaver. A percutaneous delivery system was successful in allowing an anterior column reconstruction using PMMA as a strut graft in selected cadavers. We demonstrated that a dual-tube MIS approach to thoracic corpectomy is technically feasible. Additionally, spinal stabilization can be achieved via percutaneous PMMA administration. This approach may provide a minimally invasive option in the treatment of select spinal metastases.

Authors:

Michael Musacchio, M.D.; Rush University, Chicago, Illinois, USA; Nimesh Patel, M.D., Rush University, Chicago, Illinois, USA; Bradley Bagan, M.D., Rush University, Chicago, Illinois, USA; Harel Deutsch, M.D., Rush University, Chicago, Illinois, USA; Alexander R. Vaccaro, M.D., Thomas Jefferson University, Philadelphia, Pennsylvania, USA; John Ratliff, M.D., Rush University, Chicago, Illinois, USA, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

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