Fracture-related Thoracic Kyphotic Deformity Correction by Single-stage Posterolateral Vertebrectomy With Circumferential Reconstruction and Stabilization: Outcomes in 30 Cases

Perioperative characteristics, complications, and outcomes of single-level versus multilevel thoracic corpectomies via modified costotransversectomy approach

STUDY DESIGN

Retrospective case series.

OBJECTIVE

To compare perioperative end points and outcomes of single-level versus multilevel corpectomy performed using a modified costotransversectomy approach.

SUMMARY OF BACKGROUND DATA

Single-level corpectomy via posterolateral approach has been shown to be an effective alternative to the traditional anterior thoracotomy approach. However, there is a paucity of studies that have examined multilevel thoracic corpectomy via posterolateral approach.

METHODS

Using electronic medical records, we identified a consecutive population of adult patients who underwent modified costotransversectomy corpectomy in the thoracic region between 2006 and 2009. Patients were stratified by number of corpectomies performed into either a single-level or multilevel group. With the use of baseline descriptive statistics and multivariate analysis, perioperative parameters and follow-up outcomes were assessed between the 2 groups.

RESULTS

A total of 40 patients were included in the final analysis, with 25 patients in the single-level group and 15 patients in the multilevel group. Mean follow-up was 16.1 months. Overall complication rate was 37.5%. Between the 2 groups, there were no significant differences in operative time, blood loss, transfusion rate, quantity of blood transfused, length of hospital stay, or complication rates. Also, there were no significant differences in repeat surgery rate, Medical Research Council strength, Nurick score, or pain at most recent follow-up, and all groups gained a comparable magnitude of benefit from surgery.

CONCLUSION

Multilevel corpectomy via modified costotransversectomy approach in the thoracic region is a feasible and effective option that does not seem to be associated with significantly increased morbidity. The degree of clinical improvement also seems comparable with single-level corpectomy.

Anterior construct location following vertebral body metastasis reconstruction through a posterolateral transpedicular approach: does it matter?

Object

The posterolateral transpedicular approach (PTA) is a widely used method for the surgical treatment of vertebral body metastases. It is crucial to understand the optimal location of the anterior graft in terms of sound and durable reconstruction following PTA. The purpose of this study was to investigate whether postoperative construct stability is related to the location of anterior grafts.

Methods

The authors conducted a retrospective review of 45 cases of metastatic spine disease with epidural tumor extension in which patients underwent circumferential decompression and fusion by means of PTA. Mechanical (anterior construct stability), pain (visual analog scale score), and neurological (American Spinal Injury Association scale) outcomes were evaluated and correlated with the anterior graft location (lateral or central) and surgical approach (unilateral or bilateral), number of decompressed levels, types of anterior graft, screw density of posterior fixation (number of screws used divided by the number of pedicles spanned), and kyphotic angle change from the immediate postoperative period to the most recent follow-up.

Results

Seven of 45 constructs were judged unstable—5 with a lateral location of the anterior graft and 2 with a central location.

The anterior graft was located laterally in 31 cases (69%), centrally in 11 (24%), and bilaterally in 3 (7%). A unilateral approach was used in 33 cases and a bilateral approach in 12. Neither the location of the anterior graft nor the approach had a significant effect on the stability of the reconstructed spine (p > 0.05). There was a significant difference in construct stability between the single-level decompression group (33 patients) and the multiple-level decompression group (12 patients) (p = 0.0001). The types of anterior graft, screw density, and kyphotic angle change were not correlated to the mechanical outcome.

Conclusions

The anterior graft location showed no significant relationship to the final mechanical, pain, and neurological outcomes.

Corpectomia da coluna toracolombar com colocação de cage por acesso único via posterior: técnica cirúrgica e resultados de seis pacientes

OBJETIVO: Avaliar retrospectivamente os resultados de uma série de pacientes submetidos à corpectomia torácica e/ou lombar por via exclusivamente posterior associado à colocação de cage e à artrodese instrumentada segmentar e descrever a técnica cirúrgica. MÉTODOS: Foram avaliados retrospectivamente seis pacientes portadores de colapso vertebral, instabilidade biomecânica ou lesão neurológica por diferentes etiologias. Estes pacientes apresentavam indicação de descompressão neural e receberam indicação para a realização de corpectomia e reconstrução circunferencial com cage sendo realizado por via exclusivamente posterior. RESULTADOS: Quatro pacientes eram do sexo masculino e dois do sexo feminino. A idade média foi de 58 anos (22 a 82 anos) com tempo médio de acompanhamento de 10,5 meses (2 a 24 meses). Em três casos a ressecção foi de um corpo vertebral e em três casos de dois corpos vertebrais. Todos os pacientes apresentaram melhora do seu estado neurológico e melhora da dor lombar ou radicular. As indicações ao procedimento foram três casos por espondilodiscite, um por fratura osteoporótica, um tumor metastático e um tumor primário. Três pacientes apresentaram complicações necessitando de revisão cirúrgica evoluindo com melhora dos sintomas. As complicações foram fístula liquórica, radiculopatia lombar, infecção de ferida operatória, meningite e falha da instrumentação. CONCLUSÃO: Os pacientes submetidos à corpectomia por via exclusivamente posterior apresentaram resultados favoráveis com melhora do déficit neurológico ou dor em todos os casos. Esta técnica mostrou-se eficiente na reconstrução circunferencial da coluna evitando as complicações da abordagem tradicional por dupla via.