Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana, USA.
J Neurosurg Spine. 2010 Nov;13(5):630-5. doi: 10.3171/2010.5.SPINE09717.
Transpedicular thoracic vertebrectomy (TTV) is a safe alternative to the more standard transthoracic approach. A TTV is most commonly used to address vertebral body fractures due to tumor or trauma. Transpedicular reconstruction of the anterior column with cage/bone traditionally requires unilateral thoracic nerve root sacrifice. In a cadaveric model, the authors evaluated the feasibility of transpedicular anterior column reconstruction without nerve root sacrifice. If feasible, this may be a reasonable approach that could be extended to the lumbar spine where nerve root sacrifice is not an option.
A TTV was performed in 8 fixed cadaveric specimens. In each specimen, an alternate vertebra (either odd or even) was removed so that single-level reconstruction could be evaluated. The vertebrectomy included facetectomy, adjacent discectomies, and laminectomy; however, the nerve roots were preserved. The authors then evaluated the feasibility of inserting a titanium mesh cage (Medtronic Sofamor Danek) without neural sacrifice.
Transpedicular anterior cage reconstruction could be safely performed at all levels of the thoracic spine without nerve root sacrifice. The internerve root space varied from 18 mm at T2-3 to 27 mm at T11-12; thus, the size of the cage that was used also varied with level.
Cage reconstruction of the anterior column could be safely performed via the transpedicular approach without nerve root sacrifice in this cadaveric study. Removal of the proximal part of the rib in addition to a standard laminectomy with transpedicular vertebrectomy provided an excellent corridor for anterior cage reconstruction at all levels of the thoracic spine without nerve root sacrifice.
经椎弓根胸椎切除术（TTV）是一种比经胸入路更为安全的替代方法。TTV 最常用于治疗因肿瘤或外伤导致的椎体骨折。经皮椎弓根前路重建采用 cage/bone 时，传统上需要单侧胸神经根牺牲。在尸体模型中，作者评估了不牺牲神经根进行经皮椎弓根前路重建的可行性。如果可行，这可能是一种合理的方法，可以扩展到不需要牺牲神经根的腰椎。
在 8 具固定尸体标本中进行 TTV。在每个标本中，切除一个交替的椎体（奇数或偶数），以便评估单节段重建。椎体切除术包括关节突切除术、相邻椎间盘切除术和椎板切除术；然而，神经根得以保留。然后，作者评估了不牺牲神经根插入钛网 cage（美敦力 Sofamor Danek）的可行性。
在不牺牲神经根的情况下，TTV 可安全地在胸椎的所有节段进行前路 cage 重建。神经根间隙在 T2-3 为 18mm，在 T11-12 为 27mm；因此，使用的 cage 大小也随节段而变化。
在这项尸体研究中，经皮椎弓根入路不牺牲神经根即可安全进行 cage 重建。除了标准的椎板切除术外，还切除肋骨的近端部分，为所有胸椎节段不牺牲神经根的前路 cage 重建提供了一个极好的通道。
