Minimally invasive lateral transpsoas approach for lumbar corpectomy and stabilization

Abstract

Background: Here, we present our experience with the minimally invasive (MI) transpsoas approach for lumbar corpectomy and stabilization. Transpsoas approach accesses the lumbar spine and includes both the direct lateral interbody fusion and extreme lateral interbody fusion techniques. Both procedures utilize a tubular retractor system which facilitates adequate retraction and direct visualization of the target, while supposedly reducing soft tissue trauma.

Case description: We evaluated two patients, one with a traumatic L2 wedge compression fracture and the other with an L3 pathological compression fracture due to multiple myeloma. Both patients underwent MI transpsoas lumbar corpectomy, anterior column reconstruction with an expandable cage, and posterior pedicle screw instrumentation to correct a kyphotic deformity. Both patients were mobilized on the 1^st postoperative day and experienced significant postoperative pain relief.

Conclusion: In two cases involving L2 and L3 compression fractures, MI transpsoas lumbar corpectomy was safely performed, with reduced perioperative and postoperative morbidity. Here, the transpsoas approach also allowed for early mobilization, adequate postoperative biomechanical stability, and resulted in immediate good outcomes.

Keywords: Lateral approach; Lumbar corpectomy; Minimally invasive surgery; Transpsoas approach.

Figure 1:

Case 1 – (a) Immediate postoperative fluoroscopic image of lumbosacral spine showing L2 wedge compression with pedicle screw at L1–L3 after primary surgery. (b and c) Anteroposterior/ lateral fluoroscopic image of lumbosacral spine at 1 year post instrumentation showing progressive L2 vertebral body collapse with pedicle screw loosening at L1 and L3.

Figure 2:

Case 1 – (a) Patient positioned in the right lateral decubitus position with the kidney bridge raised and table bent to provide access to the lumbar spine. (b and c) Localizing the target vertebrae on fluoroscopy and marking the safe zone to access the vertebrae. (d) Planned incision. (e) Lateral lumbar fluoroscopic image showing placement of the corpectomy cage and posterior pedicle screw fixation from D12 to L4.

Figure 3:

(a-c) Case 2 – Preoperative sagittal, coronal, and axial magnetic resonance imaging of the lumbar spine revealed severe compression collapse fracture of the L3 vertebral body with T2 marrow hyperintensities and mild retropulsion of the fracture fragments with thecal sac compression.

Figure 4:

(a-c) Case 2 – Lateral and anteroposterior lumbosacral fluoroscopic image showing compression fracture L3 with diffuse osteopenia.

Figure 5:

Case 2 – (a and b) Lateral and anteroposterior fluoroscopic image showing expandable cage with pedicle screw at L2 and L4. (c) Postoperative radiograph of lumbosacral spine at 4 months (anteroposterior) showing placement of the corpectomy cage and posterior pedicle screw fixation from L2 to L4.