Liu Fengyu, Gu Zhenfang, Sun Xianze, Meng Xianzhong
Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Spine Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, China.
Front Surg. 2025 Feb 24;12:1567243. doi: 10.3389/fsurg.2025.1567243. eCollection 2025.
The thoracolumbar junction (T10-L2) is a common site for spinal disorders such as fractures, tumors, and infections. Thoracolumbar vertebral corpectomy can be performed through the extracoelomic spaces approach (retropleural, retroperitoneal, and retrodiaphragmatic). The standard for selecting rib resection has not been described. We explored the criteria for rib resection in minimally invasive lateral approach thoracolumbar corpectomy through radiographic analysis and case illustrations.
We proposed the criteria for rib excision after reviewing the three-dimensional CT imaging of 300 patients' ribs. The vertebral body is divided obliquely into four zones. Ribs need to be removed when they overlap zones II and III, but not when they overlap zones I and IV. Surgery was performed according to this criteria to verify the feasibility of this criteria.
From January 2024 to October 2024, 19 patients experienced minimally invasive lateral approach thoracolumbar corpectomy. Sixteen patients needed rib resection (the ninth rib resection: 4, the 10th rib resection: 12). Three patients did not require rib resection but underwent vertebra corpectomy through the intercostal. Two patients had pleural tear and were repaired during surgery. The VAS reduced from 8.9 ± 1.1 preoperatively to 1.2 ± 0.9 at final follow-up ( < 0.001).
This may be an appropriate criterion for determining rib resection in minimally invasive lateral approach thoracolumbar corpectomy. The vertebral body is divided obliquely into four zones. Ribs need to be removed when they overlap zones II and III, but not when they overlap zones I and IV.
胸腰段交界处（T10-L2）是骨折、肿瘤和感染等脊柱疾病的常见部位。胸腰段椎体次全切除术可通过体腔外间隙入路（胸膜后、腹膜后和膈后）进行。目前尚未描述肋骨切除的选择标准。我们通过影像学分析和病例说明探讨了微创外侧入路胸腰段椎体次全切除术中肋骨切除的标准。
我们在回顾300例患者肋骨的三维CT成像后提出了肋骨切除标准。椎体被斜向划分为四个区域。当肋骨与II区和III区重叠时需要切除，但与I区和IV区重叠时则无需切除。根据该标准进行手术以验证其可行性。
2024年1月至2024年10月，19例患者接受了微创外侧入路胸腰段椎体次全切除术。16例患者需要切除肋骨（第9肋骨切除：4例，第10肋骨切除：12例）。3例患者不需要切除肋骨，但通过肋间进行了椎体次全切除术。2例患者出现胸膜撕裂并在手术中进行了修复。视觉模拟评分（VAS）从术前的8.9±1.1降至末次随访时的1.2±0.9（<0.001）。
这可能是确定微创外侧入路胸腰段椎体次全切除术中肋骨切除的合适标准。椎体被斜向划分为四个区域。当肋骨与II区和III区重叠时需要切除，但与I区和IV区重叠时则无需切除。
