Modified lateral extracavitary approach for vertebral column resection and expandable cage reconstruction of thoracic spinal metastases

BACKGROUND: Spinal metastasis is common and can be associated with considerable morbidity. Vertebral resection and reconstruction have been shown to preserve neurological function and decrease pain. Most commonly, two-stage, combined anterior/posterior approaches are performed to surgically address significant vertebral metastasis. Recently, single-stage posterior approaches for vertebrectomies have been performed more often as a result of advances in instrumentation and anesthesia. The objective is to describe a series of patients with metastatic thoracic spine tumors who were treated using a modified, lateral extracavitary approach for a posterior-only vertebral column resection and expandable cage reconstruction. METHODS: A retrospective analysis of 21 cases and 20 patients was performed. RESULTS: The average estimated blood loss and length of surgery were 1700 ml (range, 200–7600 ml) and 6.8 h (range, 4–9 h), respectively. The mean follow-up was 14 months (range, 4–30 months). One patient had a permanent neurological deficit as a result of a postoperative hematoma. Of the five patients who were unable to walk prior to surgery, two regained the ability to ambulate. The total complication rate was 43% with majority being minor. A total of 94% of patients had durable preservation of the neurological function. CONCLUSION: The posterior approach for vertebral column resection and reconstruction is a viable alternative to the standard combined approach. We demonstrate the feasibility of performing the lateral extracavitary approach through a midline incision from T1 to T12. This less invasive approach continues to evolve as instrumentation becomes more advanced and possesses significant advantages in the oncologic setting.