Mohammad Hassan A Noureldine1, Elliot Pressman2, Paul R Krafft2, Donald A Smith2, Mark S Greenberg2, Puya Alikhani3. 1. Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA. 2. University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA. 3. University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA. Electronic address: palikhan@usf.edu.
Abstract
BACKGROUND: The growing interest in minimally invasive approaches to the thoracic and lumbar spine is mostly secondary to the high surgical morbidity and complication rates associated with conventional open approaches. OBJECTIVE: To report the largest series of patients with thoracic and lumbar vertebral osteomyelitis who underwent multilevel corpectomies using the minimally invasive lateral (MIL) retropleural and retroperitoneal approaches. METHODS: The surgical techniques of the MIL approaches are illustrated and described in detail. The MIL retropleural approach was performed in 9, MIL retroperitoneal approach in 3, and combined MIL retropleural/retroperitoneal approach in 2 patients with thoracic, lumbar and thoracolumbar vertebral osteomyelitis, respectively. RESULTS: Multilevel corpectomies were successfully accomplished in all 14 patients using the MIL approaches (11 patients with 2-level corpectomy, 2 patients with 3-level corpectomy, and 1 patient with extension of a 3-level corpectomy to 6 levels). Correction of kyphotic deformity was achieved postoperatively in all 14 patients and remained stable with no proximal junctional kyphosis for a median of 10 months of follow-up on 10 patients; 4 patients were lost to follow-up after discharge from hospital. Posterior instrumentation was performed in 12 patients to further support the spinal alignment. CONCLUSION: The MIL retropleural and retroperitoneal approaches described in this manuscript are feasible and safe in achieving multilevel corpectomies, anterior column reconstruction, and spinal deformity correction is patients with thoracic, lumbar, and thoracolumbar vertebral osteomyelitis.
BACKGROUND: The growing interest in minimally invasive approaches to the thoracic and lumbar spine is mostly secondary to the high surgical morbidity and complication rates associated with conventional open approaches. OBJECTIVE: To report the largest series of patients with thoracic and lumbar vertebral osteomyelitis who underwent multilevel corpectomies using the minimally invasive lateral (MIL) retropleural and retroperitoneal approaches. METHODS: The surgical techniques of the MIL approaches are illustrated and described in detail. The MIL retropleural approach was performed in 9, MIL retroperitoneal approach in 3, and combined MIL retropleural/retroperitoneal approach in 2 patients with thoracic, lumbar and thoracolumbar vertebral osteomyelitis, respectively. RESULTS: Multilevel corpectomies were successfully accomplished in all 14 patients using the MIL approaches (11 patients with 2-level corpectomy, 2 patients with 3-level corpectomy, and 1 patient with extension of a 3-level corpectomy to 6 levels). Correction of kyphotic deformity was achieved postoperatively in all 14 patients and remained stable with no proximal junctional kyphosis for a median of 10 months of follow-up on 10 patients; 4 patients were lost to follow-up after discharge from hospital. Posterior instrumentation was performed in 12 patients to further support the spinal alignment. CONCLUSION: The MIL retropleural and retroperitoneal approaches described in this manuscript are feasible and safe in achieving multilevel corpectomies, anterior column reconstruction, and spinal deformity correction is patients with thoracic, lumbar, and thoracolumbar vertebral osteomyelitis.