gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

The expanded extreme lateral approach to the lumbar and thoracic spine – a minimally invasive surgical technique for total vertebral body replacement

Meeting Abstract

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

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.10-04

DOI: 10.3205/09dgnc065, URN: urn:nbn:de:0183-09dgnc0657

Published: May 20, 2009

© 2009 Rainov et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Minimally invasive surgical approaches to the spine are increasingly used instead of large exposure techniques. We describe our experience with a surgical approach initially employed for lumbar extreme-lateral interbody fusion (XLIF).

Methods: The original retroperitoneal, trans-psoas XLIF approach to the anterior lumbar spine was expanded to a lateral transthoracic intra- or extrapleural approach to the thoracic spine. Adequate surgical exposure was achieved with an illuminated four-bladed retractor (MaXcess®, NuVasive Inc.), which allows for the introduction of a large load-bearing implant through a small skin incision. The lumbar plexus was protected by the use of automated intraoperative EMG-monitoring. The extended XLIF approach allows for the total removal of 1–3 vertebral bodies through a single 6–8 cm incision. An expandable metal implant (cage) is used for vertebral body replacement and for alignment of spine deformity. The surgical goals are achieved with minimal trauma to soft tissues and with minimal blood loss.

Results: We demonstrate the feasibility of the XLIF approach for thoracic and lumbar corpectomy and total vertebral body replacement. A group of 15 patients (7 male, 8 female) with fractures or metastatic/inflammatory destruction of vertebral bodies has undergone corpectomy and total vertebral body replacement. Six patients underwent thoracic and 9 lumbar corpectomy. One single vertebral body was replaced in 12 cases and 2 vertebral bodies in 3 cases.

Conclusions: Our preliminary experience confirms that total vertebral body replacement via XLIF approach is safe, minimizes blood loss, allows for continuous bilateral ventilation of the lungs during transthoracic surgery, and has the potential to become a surgical standard. In our hands this approach offers convenient and wide access to the relevant structures of the spine without the serious risks and potentially severe complications of open trans-abdominal or trans-thoracic procedures.