Features of anterior and lateral vertebral body surface dissection from posterior approach

Vladimir A. Pyatikop, Sergiy N. Romaev, Yuriy A. Babalyan

Abstract


Introduction. Wide dissection of anterior and lateral vertebral body surface in thoracic and lumbar region from posterior only approach is one of critical step in performing three-column osteotomy (PSO, PVCR, TES), which are often used in complex inflammation, tumor, deformity spine surgery.

Objective. Studying anatomical features of anterior and lateral vertebral body surface dissection in thoracic and lumbar region from posterior only approach.

Materials and methods. Twenty surgical procedures were done on 5 non-embalmed bodies. Procedures were provided in autopsy room. On every cadaver full anterior, lateral vertebral body dissection from posterior approach were done on upper-thoracic (Th1-Th4), middle-thoracic (Th5-Th10), thoraco-lumbar junction (Th11-L2), lower lumbar levels (L3-L5).

Results. Neurovascular bundle was easily isolated on every level, but was less mobile (up to 0.5 cm) in upper thoracic region. One rib resection window was too narrow for good visual control in all dissection procedure. Dissection of lateral wall of vertebral body on lumbar level required providing some sharp dissection maneuver for forming plane between m. psoas major and periosteum. Anterior and lateral lower third L4, L5 vertebral dissection was always accompanied with major vascular manipulation.

Conclusions. Two, three level rib resection, transversectomy provide enough space for easy dissection while direct vision of anterior and lateral vertebral body wall on Th2-L2 levels, with minimal risk of complications. Posterior circumferential dissection on L4, L5 levels is inexpedient. Anterior, lateral L3 vertebral body surface can be easily performed with little technical difficulties.


Keywords


сostectomy; transversectomy; sharp and blunt dissection; parietal pleura; diaphragm fixation zone; m. psoas major; segmental vessels

References


1. Demirkiran G, Dede O, Karadeniz E, Olgun D, Ayvaz M, Yazici M. Anterior and Posterior Vertebral Column Resection Versus Posterior-only Technique: A Comparison of Clinical Outcomes and Complications in Congenital Kyphoscoliosis. Clin Spine Surg. 2017 Aug;30(7):285-290. [CrossRef] [PubMed]

2. Zozulya YuA, Slynko YeI, Shamaev MI, Chebotareva LL, Chepkiy LP. [Spinal cord tumors]. Zozulya YuA, editor. Kiev: Kniga-plyus; 2010. Russian.

3. Lu DC, Lau D, Lee JG, Chou D. The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies. J Neurosurg Spine. 2010 Jun;12(6):583-91. [CrossRef] [PubMed]

4. Dalgic A, Uckun O, Acar HI, Okay O, Daglioglu E, Ergungor F, Belen D, Tekdemir Single-stage posterolateral Corpectomy and circumferential stabilization without laminectomy in the upper thoracic spine: cadaveric study and report of three cases. Turk Neurosurg. 2010 Apr;20(2):231-40. [CrossRef] [PubMed]

5. Fang T, Dong J, Zhou X, McGuire RA Jr, Li X. Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine. J Neurosurg Spine. 2012 Oct;17(4):271-9. [CrossRef] [PubMed]

6. Kawahara N, Tomita K, Murakami H, Demura S, Yoshioka K, Kato S. Total en bloc spondylectomy of the lower lumbar spine: a surgical techniques of combined posterior-anterior approach. Spine (Phila Pa 1976). 2011 Jan 1;36(1):74-82. [CrossRef] [PubMed]

7. Huang L, Chen K, Ye JC, Tang Y, Yang R, Wang P, Shen HY. Modified total en bloc spondylectomy for thoracolumbar spinal tumors via a single posterior approach. Eur Spine J. 2013 Mar;22(3):556-64. [CrossRef] [PubMed] [PubMed Central]

8. Bolshakov OP, Semenov GP. [Operative surgery and topographical anatomy]. St. Petersburg: [publisher unknown]; 2004. Russian.

9. Miscusi M, Domenicucci M, Polli FM, Forcato S, De Giorgio F, Raco A. Spondylectomy of T-2 according to the Tomita technique via an extended Fessler approach: a cadaveric study. J Neurosurg Spine. 2012 Jan;16(1):22-6. [CrossRef] [PubMed]

10. Tomita K, Kawahara N, Murakami H, Demura S. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci. 2006 Jan;11(1):3-12. [CrossRef] [PubMed] [PubMed Central]

11. Tomita K, Toribatake Y, Kawahara N, Ohnari H, Kose H. Total en bloc spondylectomy and circumspinal decompression for solitary spinal metastasis. Paraplegia. 1994 Jan;32(1):36-46. [CrossRef] [PubMed]


GOST Style Citations






DOI: https://doi.org/10.25305/unj.90414

Copyright (c) 2018 Vladimir A. Pyatikop, Sergiy N. Romaev, Yuriy A. Babalyan

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.