Features of anterior and lateral vertebral body surface dissection from posterior approach
Keywords:сostectomy, transversectomy, sharp and blunt dissection, parietal pleura, diaphragm fixation zone, m. psoas major, segmental vessels
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.
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