Minimally invasive retroperitoneal approach for lumbar corpectomy and anterior reconstruction

Abstract

<jats:p content-type="fine-print">✓ The anterior decompressive procedure in which spinal fusion is performed is considered an effective treatment for thoracolumbar fractures and tumors. However, it is also known to be associated with considerable surgery-related trauma. The purpose of this study was to show that lumbar corpectomy and anterior reconstruction can be performed via a minimally invasive retroperitoneal approach (MIRA) and therefore the surgical approach—related trauma can be reduced.</jats:p> <jats:p content-type="fine-print">The authors studied retrospectively the hospital records and radiological studies obtained in five patients (mean age 67.4 years, range 59–76 years) who underwent lumbar corpectomy and spinal fusion via an MIRA followed by posterior fixation. Four patients presented with osteoporotic compression fractures at L-2 and L-3, and one patient presented with metastatic disease in L-4 from prostate cancer. Neurological deficits due to cauda equina compression were demonstrated in all patients.</jats:p> <jats:p content-type="fine-print">The MIRA provided excellent exposure to facilitate complete decompression and anterior reconstruction in all patients, as verified on follow-up radiographic studies. All patients improved clinically. A 1-year follow-up record is available for four patients and a 6-month follow-up record for the fifth patient; continuing clinical improvement has been observed in all. Radiography demonstrated anatomically correct reconstruction in all patients, as well as a solid fusion or a stable compound union in the four patients for whom 1-year follow-up records were available.</jats:p> <jats:p content-type="fine-print">The MIRA allows the surgeon to perform anterior lumbar spine surgery via a less invasive approach. The efficacy and safety of this technique and its potential to reduce perioperative morbidity compared with conventional retroperitoneal lumbar spine surgery should be further investigated in a larger series.</jats:p>

Combined Posterior and Delayed Staged Mini-open Anterior Short-segment Fusion for Thoracolumbar Burst Fractures

“…Mini-open anterior approaches have been successfully introduced with the use of self-retaining retractor systems. [22][23][24] The table-mounted self-retaining retractor system allows a 360-degree approach to surgical openings for either anterior or posterior procedures. It allows surgeons to operate under direct vision or use endoscopes with optimal illumination of the surgical field and assures permanent stability of the surgical field.…”

“…[19][20][21] Mini-open anterior approaches have been successfully introduced with the use of self-retaining retractor systems. [22][23][24] A combined procedure with posterior decompression, short-segment stabilization, and delayed staged anterior mini-open stabilization seemed reasonable to us, as it can overcome the shortcomings of each standalone anterior or posterior approach described above. The aim of this study was to evaluate the outcome of patients with single thoracolumbar burst fracture who were treated with circumferential short-segment fusion consisting of posterior reduction, short-segment fusion, and delayed staged mini-open anterior short-segment fusion.…”

Radiculopathy Caused by Osteoporotic Vertebral Fractures in the Lumbar Spine

“…3,5,11) These neurological signs include such severe symptoms as paraparesis and bladder dysfunction, so challenging surgical treatments are often required in aged patients with fragile spines. 3,5,6,12) OVFs in the lower lumbar spine occasionally induce radiculopathy. 2) In our experience, radiculopathy develops in patients with OVF much more frequently than in patients with myelopathy or cauda equina syndrome.…”

Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine

“…Using a mini-open approach to perform the corpectomy on the anterior thoracolumbar spine was introduced at the beginning of the last decade (2000s). 2,16,18 With the use of a specific SynFrame retractor system (Synthes Spine), this approach can avoid a large wound field and is relative easy to learn.…”