Minimally Invasive Thoracic Corpectomy and Anterior Fusion in a Patient with Metastatic Disease: Case Report and Review of the Literature

Abstract

For patients with metastatic disease to the spine there are numerous surgical approaches for decompression of neural elements and maintenance of mechanical stability. The challenge is to accomplish this while minimizing patient morbidity. Here we report on the feasibility and utility of a minimally invasive extreme lateral approach to the mid to high thoracic spine for anterior decompression and fusion.

A Systematic Review of the Current Role of Minimally Invasive Spine Surgery in the Management of Metastatic Spine Disease

“…Minimally invasive spine surgery was created with the purpose of minimizing soft tissue surgical trauma and thereby accelerating postoperative care [16, 18, 43, 44], without a loss of surgical effectiveness, and was thus applicable to the management of metastatic spine disease in patients not candidate for conventional surgical intervention. More specifically, patients with single or adjacent level involvement with neurologic symptoms from spinal instability or neurological structure compression and a life expectancy of at least 3 months are considered candidate for MIS [15, 16, 18].…”

“…More specifically, patients with single or adjacent level involvement with neurologic symptoms from spinal instability or neurological structure compression and a life expectancy of at least 3 months are considered candidate for MIS [15, 16, 18]. …”

Minimally Invasive Direct Lateral Transpsoas Approach for the Resection of a Lumbar Plexus Schwannoma: Technique Report

“…These approaches, too, have several well-known risks including hemorrhage, nerve injury, and muscle injury. 6,[8][9][10][11]13,[18][19][20] Additionally, such approaches require a prolonged hospitalization period for appropriate recovery. This case report describes a technique adapted to minimize these risks.…”

“…Based on tumor size, location, and characteristics, some of these approaches may require concomitant hemilaminectomy and facetectomy with possible arthrodesis. 2,[6][7][8][9][10][11][12] Minimally invasive techniques offer an advantage over traditional surgical methods by reducing soft tissue trauma and blood loss, thus lessening approach-associated morbidity. 7,8,13 A lateral transpsoas approach, as popularized in lateral interbody fusion surgery, is the most direct technique to approach retroperitoneal lumbar plexus tumors and should help to reduce postoperative pain and hospital stays and expedite the return to activities of daily living.…”

“…7,8,13 A lateral transpsoas approach, as popularized in lateral interbody fusion surgery, is the most direct technique to approach retroperitoneal lumbar plexus tumors and should help to reduce postoperative pain and hospital stays and expedite the return to activities of daily living. [6][7][8][13][14][15] Furthermore, such an approach precludes the need for an access surgeon. 13 In this report, we describe a direct lateral minimally invasive approach to the retroperitoneum utilizing a tubular retractor and directional electromyography (EMG) for complete resection of an L4 nerve root schwannoma distal to the dorsal root ganglia in the psoas muscle.…”