Shengbin Huangxs1,2, Peter A Christiansen1, Haitao Tan2, Justin S Smith1, Mark E Shaffrey1, Juan S Uribe3, Christopher I Shaffrey4, Chun-Po Yen1. 1. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia. 2. Department of Orthopedics, Guigang City People's Hospital, Guigang, Guangxi, People's Republic of China. 3. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona. 4. Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina.
Abstract
BACKGROUND: Neoplastic, traumatic, infectious, and degenerative pathologies affecting the thoracolumbar junction pose a unique challenge to spine surgeons. Posterior or anterior approaches have traditionally been utilized to treat these lesions. Although minimally invasive surgeries through a lateral approach to the thoracic or lumbar spine have gained popularity, lateral access to the thoracolumbar junction remains technically challenging due to the overlying diaphragm positioned at the interface of the peritoneum and pleura. OBJECTIVE: To describe a mini-open lateral retropleural retroperitoneal approach for pathologies with spinal cord/cauda equina compression at the thoracolumbar junction. METHODS: A mini-open lateral corpectomy is described in detail in a patient with an L1 metastatic tumor. RESULTS: Satisfactory decompression and spinal column reconstruction were achieved. The patient obtained neural function recovery following the procedure with no intra- or postoperative complications. CONCLUSION: The morbidities associated with traditional posterior or anterior approaches to thoracolumbar junction pathologies have led to a growing interest in minimally invasive alternatives. The mini-open lateral approach allows for a safe and efficacious corpectomy and reconstruction for thoracolumbar junction pathologies. Thorough understanding of the anatomy, particularly of the diaphragm, is critical. This approach will have expanded roles in the management of patients with thoracolumbar neoplasms, fractures, infections, deformities, or degenerative diseases.
BACKGROUND: Neoplastic, traumatic, infectious, and degenerative pathologies affecting the thoracolumbar junction pose a unique challenge to spine surgeons. Posterior or anterior approaches have traditionally been utilized to treat these lesions. Although minimally invasive surgeries through a lateral approach to the thoracic or lumbar spine have gained popularity, lateral access to the thoracolumbar junction remains technically challenging due to the overlying diaphragm positioned at the interface of the peritoneum and pleura. OBJECTIVE: To describe a mini-open lateral retropleural retroperitoneal approach for pathologies with spinal cord/cauda equina compression at the thoracolumbar junction. METHODS: A mini-open lateral corpectomy is described in detail in a patient with an L1 metastatic tumor. RESULTS: Satisfactory decompression and spinal column reconstruction were achieved. The patient obtained neural function recovery following the procedure with no intra- or postoperative complications. CONCLUSION: The morbidities associated with traditional posterior or anterior approaches to thoracolumbar junction pathologies have led to a growing interest in minimally invasive alternatives. The mini-open lateral approach allows for a safe and efficacious corpectomy and reconstruction for thoracolumbar junction pathologies. Thorough understanding of the anatomy, particularly of the diaphragm, is critical. This approach will have expanded roles in the management of patients with thoracolumbar neoplasms, fractures, infections, deformities, or degenerative diseases.
Authors: Vadim A Byvaltsev; Andrei A Kalinin; Roman A Polkin; Valerii V Shepelev; Marat A Aliyev; Yermek K Dyussembekov Journal: J Craniovertebr Junction Spine Date: 2021-09-08
Authors: Christoph Wipplinger; Sara Lener; Christoph Orban; Tamara M Wipplinger; Anto Abramovic; Anna Lang; Sebastian Hartmann; Claudius Thomé Journal: Acta Neurochir (Wien) Date: 2022-06-11 Impact factor: 2.816