gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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

Meeting Abstract

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  • 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

Published: April 28, 2011

© 2011 Heidecke 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 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.