gms | German Medical Science

Objective: Anterior approaches to the thoracic spine enable corpectomy for different pathologies and vertebral replacement. However, this approach has previously required a thoracotomy incision, which is associated with significant perioperative morbidity, pain, and the potential for compromised ventilation and subsequent respiratory sequelae. The extreme lateral approach to the anterior spine has been used to treat degenerative disorders of the lower thoracic and lumbar spine, and reduces the potential complications compared with the anterior transpleural approach. We describe the first use of a new fixed, easily used retractor system for transthoracal corpectomy via a minimally invasive extreme lateral approach.

Methods: We used this new retractor system for different indications, such as pathological fractures because of osteoporosis or vertebral metastasis and spondylitis/spondylodiscitis with consecutive vertebral instability. The procedure was combined with dorsal stabilization, partly combined with cement screw augmentation.

Results: 12 patients were treated by extreme lateral transthoracal corpectomy and vertebral replacement. This new way of retractor system was easily and X-ray guided fixed into the adjacent vertebral levels via a small thoracotomy incision (4-7cm) depending on corpectomy levels. It could be used from spinal vertebra TH4 to L1 from both sides without significant compromised ventilation, severe thoracic pain and with decreased morbidity.

Conclusion: This new fixed retractor system for transthoracal, extreme lateral approach to the spine is feasible and safe for degenerative discectomy or corpectomy combined with vertebral replacement by any cages. Further, even young residents less experienced in transthoracal approaches are able to perform this surgery without long lasting learn curves.