gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Easy minimalinvasive retractor system for the extrem lateral transthoracal approach – technical note

Meeting Abstract

  • Christian Ewelt - Klinik für Neurochirurgie, Universitätsklinik Münster, Münster, Deutschland
  • Nils Warneke - Münster, Deutschland
  • Michael Schwake - Münster, Deutschland
  • Eric Jose Suero Molina - Münster, Deutschland
  • Thomas Fortmann - Münster, Deutschland
  • Walter Stummer - Münster, Deutschland
  • Mark Klingenhöfer - Dresden, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.06.07

doi: 10.3205/17dgnc215, urn:nbn:de:0183-17dgnc2150

Published: June 9, 2017

© 2017 Ewelt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



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.