gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Corpectomy and vertebral body replacement in the lumbar and thoracic spine – the extreme lateral approach

Meeting Abstract

Suche in Medline nach

  • V. Heidecke - Neurochirurgische Klinik, Klinikum Augsburg, Augsburg, Deutschland
  • N.G. Rainov - Neurochirurgische Klinik, Klinikum Augsburg, Augsburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMI.02.06

DOI: 10.3205/11dgnc181, URN: urn:nbn:de:0183-11dgnc1819

Veröffentlicht: 28. April 2011

© 2011 Heidecke et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Minimally invasive surgical approaches to the spine are increasingly used instead of large and more invasive exposure techniques. We present our experience with total vertebral body replacement using a minimally invasive surgical approach to the anterior spine, the extreme-lateral interbody fusion (XLIF) approach.

Methods: The original retroperitoneal trans-psoas XLIF approach to the anterior lumbar spine was expanded to a transthoracic intrapleural approach to the thoracic spine (below Th6). Adequate surgical exposure was achieved with an illuminated four-blade retractor (NuVasive Inc., USA), which allows for the introduction of a large load-bearing implant through a relatively small skin incision (6–7 cm length). The lumbar plexus in the psoas muscle was protected by the use of automated intraoperative EMG-monitoring.

Results: The XLIF approach allowed us to carry out a corpectomy of 1–3 vertebral bodies through a single incision. The surgical goals were achieved with minimal trauma to soft tissues and with minimal blood loss. A group of 50 patients with spinal fractures or metastatic/inflammatory destruction of vertebral bodies underwent lumbar or thoracic corporectomy and total vertebral body replacement in up to 3 levels, with additional dorsal transpedicular instrumentation or lateral plate fixation. There were no surgery-related complications or postoperative neurological deterioration. Blood loss and tissue trauma were minimal. Patients could be mobilized on the first postoperative day after total vertebral body replacement.

Conclusions: Our current experience confirms that total vertebral body replacement via the XLIF approach is safe, minimizes blood loss, allows for continuous bilateral ventilation of the lungs during transthoracic surgery, and can be performed by neurosurgeons alone without the need for an additional approach with a surgeon. In our hands, this approach offers convenient and minimally invasive, yet sufficiently large access to the relevant anterior structures of the thoracic and lumbar spine without any serious surgery-related complications. We show here that the XLIF approach may be used as the standard approach for thoracic and lumbar vertebral body replacement.