Minimally Invasive Thoracolumbar
Costotransversectomy
and Corpectomy via a
Dual-Tube Technique:
Evaluation in a Cadaver Model
Michael Musacchio, M.D.
Resident
Rush University Department of Neurosurgery,
Chicago, Illinois, USA
Nimesh Patel, M.D.
Resident
Rush University Department of Neurosurgery,
Chicago, Illinois, USA
Bradley Bagan, M.D.
Resident
Rush University Department of Neurosurgery,
Chicago, Illinois, USA
Harel Deutsch, M.D.
Assistant Professor
Rush University Department of Neurosurgery,
Chicago, Illinois, USA
Alexander R. Vaccaro, M.D.
Professor
Thomas Jefferson University Department of Orthopedic Surgery,
Philadelphia, Pennsylvania, USA
John Ratliff, M.D.
Assistant Professor
Rush University Department of Neurosurgery,
Chicago, Illinois, USA
Thomas Jefferson University Department of Neurosurgery,
Philadelphia, Pennsylvania, USA
Minimally invasive surgery (MIS) is a promising new tool in the treatment of a variety of spinal disorders. MIS laminectomy techniques provide an effective means of achieving lumbar decompression. MIS corpectomy techniques have not been described. If feasible, such a technique would be optimal in the treatment of spinal metastatic disease, where traditional open techniques can result in a significant burden to a compromised patient. In this study, we explored the feasibility of a dual-tube minimally invasive thoracic corpectomy approach in a cadaver model. A minimally invasive thoracolumbar costotransversectomy and corpectomy were perfumed in eight adult cadavers. A dual-tube technique was used to perform a costotransversectomy followed by a corpectomy on one side, and through the opposite tube a transpedicular approach on the contralateral side. Pre- and postoperative CT scans of all cadavers were obtained to measure the cross-sectional area of the vertebral bodies in each specimen via a CT workstation. Reconstruction of the anterior column was attempted in some cadavers using polymethylmethacrylate (PMMA) cement. A successful costotransversectomy and corpectomy were completed in each cadaver. A percutaneous delivery system was successful in allowing an anterior column reconstruction using PMMA as a strut graft in selected cadavers. We demonstrated that a dual-tube MIS approach to thoracic corpectomy is technically feasible. Additionally, spinal stabilization can be achieved via percutaneous PMMA administration. This approach may provide a minimally invasive option in the treatment of select spinal metastases.
