Vertebral body replacement by posterior approach for metastatic disease in the thoracic spine--modified technique using an expandable cage.

OBJECTIVE: To describe the technique of all-posterior vertebral body replacement using an expandable cage and angled instruments. This method facilitates implant seating with limited posterior decompression useful in the setting of metastatic disease. INDICATIONS: Patients with metastatic disease of the thoracic spine with or without spinal cord compression. CONTRAINDICATIONS: Patients with a limited life expectancy of less than 6 months. Multiple foci of metastatic disease in the spine. SURGICAL TECHNIQUE: A hemilaminectomy was performed followed by nerve root sacrifice. The pleura was mobilized away from the vertebral body, after which decompression and tumor resection was performed from an all-posterior approach. An expandable vertebral body cage was inserted with a rotational manoeuvre and expanded in situ. POSTOPERATIVE MANAGEMENT: The patient was mobilized on postoperative day 1. A chest X-ray is also recommended to exclude incidental pneumothorax.
RESULTS: Four patients were operated by an all-posterior vertebral body replacement during a 6-month period. The average length of surgical procedure was 187 min (range 165-220 min). No patient required a transthoracic approach. There were no intra- or postoperative complications and all patients could be discharged to home self-ambulating.