gms | German Medical Science

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.