Cadaveric evaluation of minimally invasive posterolateral thoracic corpectomy: a comparison of 3 approaches

Abstract

Study design: A cadaver study comparing 3 different minimally invasive approaches to the anterior thoracic spine.

Objective: To assess the feasibility of minimally invasive thoracic corpectomy from a posterolateral approach and to compare surgical results from 3 approaches.

Summary of background data: Traditional posterolateral approaches to the thoracic spine are effective but are associated with a high rate of operative morbidity.

Methods: Thoracic corpectomies were performed using a modified tubular retractor starting at 3, 6, and 9 cm off of midline. Postoperative computed tomography scans were performed and analyzed to assess the extent of corpectomy and ventral decompression.

Results: From 3 to 6 to 9 cm, a significant difference in extent of corpectomy (65.8%, 81.5%, and 82.6%, P=0.02) and ventral decompression (83.6%, 90.4%, 94.6%, P=0.05) was noted between 3 cm and the more lateral approaches. The 9 cm approach required more rib resection and average working distances of 8.4 to 11.3 cm, which made the procedure more difficult technically and less suited to the length of standard instruments.

Conclusions: Minimally invasive thoracic corpectomy is feasible and a 6 cm approach off of midline appears optimal.