1621. Minimally Invasive Rib Sparing Transpedicular Thoracic Corpectomy: Technique and Case Example.
Authors: Jeffrey Byrd; Cristian Gragnaniello, MD; Jay Won Rhee, MD (Atlanta, GA)
Metastatic epidural compression in the thoracic spine has been an increasing problem in spinal surgery. Options have been developed to decompress the neural elements and provide spinal stability. Techniques for thoracic vertebra vertebral body removal have been a matter of debate, requiring special techniques to avoid traction to the spinal cord, including some sacrifice of the rib (i.e. costotrasversectomy or “trap-door” rib head osteotomy) as well a combination of approaches (i.e. posterior only, posterior and lateral, lateral extracavitary or thoracoscopic). We present our novel technique of posterior only rib sparing transpedicular thoracic corpectomy.
A midline posterior approach is carried out over the vertebras that will be fused with midline fascia opening and lateral exposure of the costo-vertebral junction. Pedicle screws are placed with free hand technique and a subsequent laminectomy is performed using an ultrasonic bone scalpel (Misonix, Farmingdale, NY). A temporary rod is placed on the contralateral side to prevent translation. The bone scalpel is used to cut through the lateral wall of the vertebral body, medial to the leaving a shell of bone to which the head of the rib attaches to. Following this the transpedicular corpectomy is performed with the aid of box osteotomes and rongeurs with minimal bleeding. The discs above and below are removed with careful endplate preparation. The space created is sufficient to place a large titanium cage without need to retract the neural elements.
Patients who underwent thoracic corpectomy for spinal metastasis with the transpedicular rib sparing approach tolerated the procedure well and had no additional deficits.
Thoracic corpectomy with the transpedicular rib sparing approach is a safe alternative to approaches that has shown not to be associated with neurologic or pulmonary complications, large blood loss or prolonged hospital stay while achieving solid circumferential decompression and fixation.