Department of Neurological Surgery, George Washington University Hospital, Washington, D.C, USA.
The George Washington University School of Medicine and Health Sciences, Washington, D.C, USA.
BMC Surg. 2024 Oct 10;24(1):303. doi: 10.1186/s12893-024-02602-0.
The thoracic corpectomy is a well-described technique for the surgical treatment of vertebral column fractures with spinal canal compromise. Traditionally, the posterolateral approach to this procedure required the removal of the approach side rib in order to introduce the corpectomy cage. This rib removal, however, has been identified as a major contributor to post-operative morbidity. Rib-sparing techniques have been shown to be beneficial in minimizing post-operative morbidity in non-spinal surgeries. Herein, we present a previously undescribed technique of a rib-sparing thoracic corpectomy that avoids sequalae of rib resection with assistance from an ultrasonic bone scalpel (UBS).
A retrospective chart review was conducted on patients having undergone this thoracic corpectomy technique. Data on patient age at operation, indication for surgery, number of corpectomies per case, estimated blood loss (EBL), operative time (OT), intra-operative complications, and post-operative length of stay (LOS) were collected and analyzed. A pictorial step-by-step guide was created to highlight the advantages of an entirely posterior rib-sparing unilateral transpedicular technique for thoracic corpectomy.
A total of 36 corpectomies were performed on 32 patients between August 2015 and March 2023. Patients ages ranged from 17 to 85 years (mean = 63). The most common indication was oncological (n = 22, 69%), followed by degenerative/traumatic deformity (n = 7, 22%), and infection (n = 3, 9%). For the cases for which data was accessible, mean EBL was 853 cc and mean OT was 178 min. The average post-operative LOS was 6.5 days.
The described surgical approach makes it possible to create a transpedicular corridor with no costectomy for implantation of an expandable titanium cage and anterior column reconstruction. The use of the UBS in this approach is critical as it minimizes bony removal and avoids sequelae of rib resection. The described technique has the potential to circumvent post-costectomy pain, thereby expediting post-operative recovery after thoracic corpectomy.
胸椎切除术是一种用于治疗伴有椎管狭窄的脊柱骨折的成熟技术。传统上，为了引入椎体切除 cage，该手术的后外侧入路需要切除入路侧肋骨。然而，这种肋骨切除已被确定为术后发病率的主要原因。肋骨保留技术已被证明在减少非脊柱手术的术后发病率方面是有益的。在此，我们介绍了一种以前未描述的保留肋骨的胸椎切除术技术，该技术在使用超声骨刀 (UBS) 的情况下避免了肋骨切除的后遗症。
对接受这种胸椎切除术技术的患者进行了回顾性图表审查。收集并分析了患者手术时的年龄、手术指征、每个病例的椎体切除术数量、估计失血量 (EBL)、手术时间 (OT)、术中并发症和术后住院时间 (LOS)。创建了一个分步的图片指南，以突出完全后侧保留肋骨的单侧经椎弓根技术用于胸椎切除术的优势。
2015 年 8 月至 2023 年 3 月期间，共对 32 名患者进行了 36 例椎体切除术。患者年龄为 17 至 85 岁（平均 63 岁）。最常见的指征是肿瘤学 (n = 22, 69%)，其次是退行性/创伤性畸形 (n = 7, 22%) 和感染 (n = 3, 9%)。对于可获得数据的病例，平均 EBL 为 853 cc，平均 OT 为 178 分钟。平均术后 LOS 为 6.5 天。
所描述的手术方法可在不进行肋骨切除术的情况下创建经椎弓根通道，以便植入可扩张钛笼和前柱重建。在这种方法中使用 UBS 至关重要，因为它最大限度地减少了骨切除并避免了肋骨切除的后遗症。所描述的技术有可能避免肋骨切除后的疼痛，从而加快胸椎切除术的术后恢复。
