Features of anterior and lateral vertebral body surface dissection on thoracic and lumbar levels from anterolateral and lateral approach
Keywords:сostectomy, parietal pleura, dissection of diaphragm, segmental vessels, sharp and blunt dissection, wide dissection of vertebral body surface
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.
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