gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Posteromedian extracavitary approach to the thoracolumbar spine for circumferential decompression and instrumentation

Posteromedianer extrakavitärer Zugang zur zirkumferenten Dekompression und Instrumentation der thorakolumbalen Wirbelsäule

Meeting Abstract

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  • corresponding author C. Thomé - Neurochirurgische Klinik, Universitätsklinikum Mannheim

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.07.01

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Thomé.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Spine lesions causing circumferential encroachment of the spinal canal usually necessitate a two-stage approach to achieve 360-degree access and decompression. The purpose of this study was to describe the posteromedian extracavitary approach via a single dorsal midline incision and to assess its effectiveness in the surgical treatment of such lesions.

Methods: In this retrospective study, 10 patients aged 64±10 years underwent a posteromedian extracavitary approach for malignant (n=7) or inflammatory (n=3) lesions of the thoracolumbar spine (T2-L2) in 2004 and 2005. The surgical procedure consisted of a complete laminectomy of the pathologic vertebra(e) and resection of the pedicles to their bases. After isolation and potential ligation of the neurovascular bundle, the transverse process, the rib head and the proximal rib were subperiostally dissected and removed. Without violating the visceral pleura, an extracavitary dissection was performed as necessary to expose the lateral portions and the anterior surface of the vertebral body to achieve partial (n=5) or complete (n=5) vertebrectomy. Reconstruction was achieved by anterior placement of a Harms cage filled with polymethylmethacrylate or autograft and by posterior pedicle screw instrumentation.

Results: Removal of 1.6±0.7 vertebrae was followed by fixation of 3.7±1.1 levels. Duration of surgery amounted to 5.4±1.7 hours. All patients had improvement of neurologic function and 6 of 8 patients, which had been non-ambulatory preoperatively, regained ambulatory function. There was one wound infection and no mortality.

Conclusions: The posteromedian extracavitary approach allows piecemeal or en bloc resection of complex lesions of the thoracolumbar spine. Circumferential exposure and decompression of the spinal cord plus three-column fixation can be safely performed in a single stage operation via a posterior midline incision.