Features of anterior and lateral vertebral body surface dissection on thoracic and lumbar levels from anterolateral and lateral approach
DOI:
https://doi.org/10.25305/unj.100853Keywords:
сostectomy, parietal pleura, dissection of diaphragm, segmental vessels, sharp and blunt dissection, wide dissection of vertebral body surfaceAbstract
Objective. To study anatomical features of anterior and lateral vertebral body surface dissection in thoracic and lumbar region from anterolateral and lateral approaches.
Materials and methods. Twenty surgeries were performed on 5 unembalmed cadavers. Procedures were provided in autopsy room. On every cadaver full lateral and anterior vertebral body dissection from right thoracotomy on middle-thoracic (Th4-Th8) level, left thoracotomy on low-thoracic (Th9-Th12) level, left extracaelomic retropleural-retrophrenic-retroperitoneal, thoracotomy with horizontal dissection of diaphragm and wide classical thoraco-abdominal with hemisection of diaphragm in thoraco-lumbar junction (Th12-L1), right and left lateral lumbotomy in middle lumbar levels (L2-L4), middle retroperitoneal in low lumbar levels (L4-L5).
Results. Parietal pleura incision allow on thoracic level ease subpleural dissection anterior and lateral surface of vertebral body, without risk of visceral and vascular complication. For direct anterior vertebral wall visualization ventral widening of approach must be done. Dissection of mid-lumbar vertebral body surface can be done as from classical left, as right sided lateral approach without vascular problem, if 3 level segmental arteries and veins ligation was done, according to technique we use. Common iliac vessels transposition can be done after meticulous ligation all venous afferents at L5 level.
Conclusions. Limited small transthoracic (rib resection 5-10 cm), extracaelomic approach in all cases far enough for full lateral wall vertebral body dissection. But no vascular control and anterior vertebral body wall visualization can be accomplished. To obtain direct control for wide dissection of vertebral body with full aorta delineation direction of surgical manipulation should be changed from posterolateral to anterolateral (rib resection 15-20 cm, hemisection of diaphragm). Ligation of all lateral afferent at L5 level of common left iliac vein allow uncomplicated dissection of L5 vetebral body wall in experiment.
References
1. D’Aliberti G, Talamonti G, Villa F, Debernardi A, Sansalone CV, LaMaida A, Torre M, Collice M. Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases. J Neurosurg Spine. 2008 Nov;9(5):466-82. [CrossRef] [PubMed]
2. Xu R, Garcйs-Ambrossi GL, McGirt MJ, Witham TF, Wolinsky JP, Bydon A, Gokaslan ZL, Sciubba DM. Thoracic vertebrectomy and spinal reconstruction via anterior, posterior, or combined approaches: clinical outcomes in 91 consecutive patients with metastatic spinal tumors. J Neurosurg Spine. 2009 Sep;11(3):272-84. [CrossRef] [PubMed]
3. Zozulya YuA, Slynko YeI, Shamaev MI, Chebotareva LL, Chepkiy LP. [Spinal cord tumors]. Zozulya YuA, editor. Kiev: Kniga-plyus; 2010. Russian.
4. Hitchon PW, Torner J, Eichholz KM, Beeler SN. Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures. J Neurosurg Spine. 2006 Aug;5(2):117-25. [CrossRef] [PubMed]
5. Puvanesarajah V, Lina IA, Liauw JA, Lo SF, Elder BD, Wolinsky JP, Bydon A, Sciubba DM, Gokaslan ZL, Witham TF. Systematic Approach for Anterior Corpectomy through a Transthoracic Exposure. Turk Neurosurg. 2016;26(4):646-52. [CrossRef] [PubMed]
6. Bohinski RJ, Rhines LD. Principles and techniques of en bloc vertebrectomy for bone tumors of the thoracolumbar spine: an overview. Neurosurg Focus. 2003 Nov 15;15(5):E7. Review. [CrossRef] [PubMed]
7. Vargas Lуpez AJ, Fernбndez Carballal C, Panadero Useros T, Aracil Gonzбlez C, Garbizu Vidorreta JM, Gonzбlez Rodrigбlvarez R. [Anterior and anterolateral approach in the treatment of thoracic and lumbar vertebral metastasis causing spinal cord compression]. Neurocirugia (Astur). 2015 May-Jun;26(3):126-36. Spanish. [CrossRef] [PubMed]
8. Bolshakov OP, Semenov GP. [Operative surgery and topographical anatomy]. St. Petersburg: [publisher unknown]; 2004. Russian.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2018 Vladimir A. Pyatikop, Sergiy N. Romaev, Yuriy A. Babalyan
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.
