Combined, Rib-Sparing, Bilateral Approach to the Ventral Mid and Low Thoracic Spine: Study on Comparative Anatomy and Surgical Feasibility

Gagliardi, Filippo; Snider, Silvia; Roncelli, Francesca; Piloni, Martina; Pompeo, Edoardo; Caputy, Anthony J.; Mortini, Pietro

doi:10.1016/j.wneu.2021.02.105

Cited by 4 publications

(7 citation statements)

References 49 publications

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“…The technique was first applied for spinal cord ventral decompression in case of spondylodiscitis and subsequently for resection of epidural tumours. Endoscopic assist enabled to completely dominate vertebral body exposure 24 (Figure 5).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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History of Evolution of Posterolateral Approaches to the Thoracic Spine: From Cure of Pott's Disease to Epidural Tumor Resection

Gagliardi

Pompeo

Domenico

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Since the end of the nineteenth century, the wide dissemination of Pott’s disease has ignited debates about which should be the ideal route to perform ventrolateral decompression of the dorsal rachis in case of paraplegia due to spinal cord compression in tuberculosis spondylitis. It was immediately clear that the optimal approach should be the one minimizing the surgical manipulation on both neural and extra-neural structures, while optimizing the exposure and surgical maneuverability on the target area. The first attempt was reported by Victor Auguste Menard in 1894, who described, for the first time, a completely different route from traditional laminectomy, called costotransversectomy. The technique was conceived to drain tubercular paravertebral abscesses causing paraplegia without manipulating the spinal cord. Over the following decades many other routes have been described all over the world, thus demonstrating the wide interest on the topic. Surgical development has been marked by the new technical achievements and by instrumental/technological advancements, until the advent of portal surgery and endoscopy-assisted techniques. Authors retraced the milestones of this history up to the present days, through a systematic review on the topic.

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Section: Accepted Manuscriptmentioning

confidence: 99%

“…21 (C) Gagliardi. 24 approach with transverse process resection on the contralateral side. A laboratory investigation was conducted to demonstrate surgical feasibility.…”

Section: Literature Reviewmentioning

confidence: 99%

History of Evolution of Posterolateral Approaches to the Thoracic Spine: From Cure of Pott's Disease to Epidural Tumor Resection

Gagliardi

Pompeo

Domenico

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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“…Linear distances and angles were measured using a dedicated ruler and goniometer, respectively. Finally, OS was calculated according to the principles, which were already described by the authors in previous reports 4,5 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Finally, the operability score (OS) was calculated according to the principles already described by the authors in previous reports. 4,5 The depth of the surgical field (D) was considered as the working distance on a target point from the level of the laminar plane. The maneuverability arc (MAC) and surgical angle of attack (SAA) were defined as the degree of freedom in manipulating surgical instruments and the angle of incidence of the surgical corridor on the vertebral plane (posterior wall), respectively, and they were calculated at the four target points.Surgical window and corridors, as well as the OS variables, are schematically depicted for each approach in ►Fig.…”

Section: Anthropometric Measurements and Operability Scorementioning

confidence: 99%

Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations

Gagliardi

Pompeo

Snider

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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IFDHs (intraforaminal disc herniations) represent a heterogeneous and relatively uncommon disease; their treatment is technically demanding due to the anatomic relationships with nerve roots and vertebral joints. Over time, several approaches have been developed without reaching a consensus about the best treatment strategy. Authors comparatively analyze surgical operability and exposure in terms of quantitative variables between the different microsurgical approaches to intraforaminal lumbar disc herniations (IFDH), defining the impact of each approach on surgical maneuverability and exposure on specific targets. A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability. Trans-articular and combined translaminar-trans-pars-interarticularis approaches result in providing the best surgical exposure and maneuverability on all targets with surgical controls on both nerve roots, at the expense of a higher risk of iatrogenic instability. Trans-pars-interarticularis approach reaches comparable levels of operability, even limited to the pure foraminal area (lateral compartment); similar findings were recorded for partial facetectomy on the medial compartment. The contralateral interlaminar approach provides good visualization of the foramen without consensual favorable maneuverability, which should be considered as the main drawback. Approach selection has to consider disease location, the possible migration of disc fragments, the degree of nerve root involvement, and risk of iatrogenic instability. According to the findings, authors propose an operative algorithm to tailor the surgical strategy, based both on the precise definition of anatomic boundaries of exposure of each approach, as well as surgical maneuverability on specific targets.

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“…The spine, as the axial bone of the human body, is the bridge supporting the upright human body, and its anatomical structure is complicated by surrounding blood vessels and nerves [ 5 ]. Spinal epithelioid sarcoma often leads to pathological vertebral fractures [ 6 ], and the growth of masses invading the spinal canal leads to spinal cord injury [ 7 ], making the treatment of spinal epithelioid sarcoma more challenging.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Published Cases of Primary Epithelioid Sarcoma of the Spine

et al. 2022

Med Sci Monit

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Background:Epithelioid sarcoma is rare, represents less than 1% of all sarcomas, usually occurs in the extremities, and rarely presents as a primary sarcoma of the spine. Publications are usually single reports or case series. We aimed to undertake a systematic review of publications of cases of primary epithelioid sarcoma of the spine to evaluate clinical presentation, diagnosis, management, and patient outcomes. Material/Methods:We searched studies on spinal epithelioid sarcoma in the PubMed database. Only studies with secondary epithelioid sarcoma or without effective data for analysis were excluded. Cases in which epithelioid sarcoma first invaded other sites and then affected the spine were also excluded. Results:Twenty-three patients from 13 studies were included in the study, aged between 14 and 65 years, and the sex ratio of female to male was 1: 2.29. The survival time was 18.7±13.8 months. The survival time of males was longer than that of females (22.9±14.4 vs 9.0±4.6, P=0.027). The onset age was linearly correlated with the size of the lesion (size=-0.161*age+11.841).The lesions located in lumbar vertebra had the worst prognosis.Postoperative radiotherapy had a statistically significant effect on survival time (P=0.040). Conclusions:This systematic review identified 23 published cases of primary epithelioid sarcoma of the spine. Pain was the main presenting symptom, and tumor size increased with patient age. Female sex and primary location in the lumbar spine were associated with poor survival. Although surgery was the first-line treatment, postoperative radiotherapy and chemotherapy may improve clinical outcomes.

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Combined, Rib-Sparing, Bilateral Approach to the Ventral Mid and Low Thoracic Spine: Study on Comparative Anatomy and Surgical Feasibility

Cited by 4 publications

References 49 publications

History of Evolution of Posterolateral Approaches to the Thoracic Spine: From Cure of Pott's Disease to Epidural Tumor Resection

History of Evolution of Posterolateral Approaches to the Thoracic Spine: From Cure of Pott's Disease to Epidural Tumor Resection

Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations

Systematic Review of Published Cases of Primary Epithelioid Sarcoma of the Spine

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