Minimally invasive retroperitoneal approach for lumbar corpectomy and reconstruction

Abstract

The authors describe two occurrences of idiopathic spinal cord herniation, an entity that has been reported previously in only 11 cases. The patients described in this report presented in midlife with Brown-Sequard syndrome. Computerized tomography myelography and magnetic resonance (MR) imaging showed ventral displacement of the spinal cord with no apparent dorsal mass. Intraspinal cerebrospinal fluid (CSF) flow studies in which phase-contrast pulse sequence cine MR imaging was used displayed a normal pattern dorsal to the spinal cord. Percutaneous intrathecal endoscopic observation did not disclose dorsal intradural cysts, but ventral adhesions were seen between the spinal cord and the dura. Microsurgical intradural exploration revealed ventrolateral herniation of the cord and a ventral root through a dural defect into an epidural arachnoid cyst. The adhesions were released, the cord was repositioned intradurally, and the dural defect was patched. The patients showed gradual improvement postsurgery, as did most of the patients in the previously reported cases. The CSF flow and endoscopic studies were found to be particularly informative, and dural patching with surgical membrane is recommended.

Anterior corpectomy via the mini-open, extreme lateral, transpsoas approach combined with short-segment posterior fixation for single-level traumatic lumbar burst fractures: analysis of health-related quality of life outcomes and patient satisfaction

“…Direct comparison of operative data and clinical outcomes to previous studies is difficult, as all previous studies include heterogeneous cohorts with regards to spinal level of pathology, disease process, and surgical approach. 8,13,16,20,24,26 Despite these discrepancies, our results compare favorably with results from previous reports. Our average estimated blood loss and length of operation are longer than that reported in the literature.…”

“…7 Since Eck's original report, several studies have reported good outcomes using the aforementioned "mini-open" lateral approach combined with posterior fixation to perform a corpectomy for burst and compression fractures, vertebral tumors and osteomyelitis, spondylodiscitis, and pseudarthrosis following previous corpectomy. 1,2,6,8,13,16,20,24,27 Our study presented herein presents a pure clinical series of patients who underwent single-level lumbar corpectomies with cage placement through a mini-open, extreme lateral, transpsoas approach supplemented with shortsegment posterior instrumentation. Direct comparison of operative data and clinical outcomes to previous studies is difficult, as all previous studies include heterogeneous cohorts with regards to spinal level of pathology, disease process, and surgical approach.…”

“…18 Since this initial report, the transpsoas approach for interbody fusion has shown promising results with few complications in patients with or without deformity. 10,23 Reports that detail the use of the transpsoas approach for anterior stabilization with corpectomy and cage placement for the treatment of unstable lumbar burst fractures are numerous, 1,2,[6][7][8]13,16,20,24 albeit none report postoperative health-related quality of life measures or assess patient satisfaction after the operation. Thus, the purpose of this study was to present the satisfaction and clinical outcomes of patients with a single-level, unstable, traumatic burst fracture treated with corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach and posterior short-segment fixation.…”

Contribution of Round vs. Rectangular Expandable Cage Endcaps to Spinal Stability in a Cadaveric Corpectomy Model

“…The potential benefits of this approach include decreased perioperative morbidity and pain, expedited ambulation, and earlier discharge from the hospital. [1][2][3][4][5][6][7][8] Vertebral body involvement by trauma, tumors, and infections often necessitate corpectomy and canal decompression followed by spinal reconstruction and stabilization. Expandable corpectomy cages are gaining popularity in reconstructive procedures of the thoracolumbar spine, as newer cage designs allow for the adjustment of cage height in situ to provide controlled distraction and deformity correction.…”

Minimally Invasive Extrapleural Retroperitoneal Approach to the Thoracolumbar Spine Junction: Clinicoradiologic Study of 29 Consecutive Cases

“…8,16 Similarly, an entirely retroperitoneal approach is often used to access the middle and lower regions of the lumbar spine (L3-5). 8,9,16 However, the thoracolumbar junction (T11-L2) is considered by many to be a challenging region of the spine to access anteriorly because of the confined space that is further complicated by the intervening diaphragm. 17 Additionally, other investigators have showed that perioperative complications related to anterior spine surgery are often approach-specific phenomena and that the surgeryrelated trauma is associated with postoperative morbidity.…”