Neurosurgery Postdoctoral Research Fellow Hurley Medical Center Flint, Michigan, United States
Introduction: Despite the positive outcomes of MIS corpectomy in the available literature, improvement in sagittal imbalance was not reported in previous studies. The goal of this study was to describe the indirect and partial correction of spine kyphotic deformities achieved by MIS posterolateral extracavitary approach (PLECA) for corpectomy. We also evaluate the outcomes and demonstrate the feasibility of MIS corpectomy in the thoracolumbar spine with reconstruction
Methods: The authors retrospectively reviewed a consecutive case series of 12 patients undergoing MIS PLECA for corpectomy and anterior column reconstruction in a single institution. Pre- and postoperative clinical and radiological parameters, including sagittal angle, were recorded. Operative details as well as the length of hospital stay, and duration of rehabilitation were also recorded. Follow-up CTs and radiographs were reviewed to assess for interbody arthrodesis.
Results: The mean age of patients was 60.7 ± 20.8 years (range 23-92 years). The etiologies of deformity included pathological fracture (41.6%), acute trauma (30%), and infection. Fifteen levels were treated; 9 patients (75%) underwent 1-level corpectomy and 3 patients (25%) had 2-level corpectomy. The most common treated levels were T7 and T9 (50% combined). An expandable cage was used in 66.7% of patients for anterior reconstruction. The mean total EBL was 764.1 ± 332.9 ml. The mean operative time was 413.3 ± 98.8 min. The average length of hospital stay was 5.8 ± 2.5 days. A consistent degree of focal correction of sagittal alignment was seen in all patients with a mean correction of sagittal angle of 7.4 ± 4.3 degrees. The mean duration of rehabilitation was 8.5 ± 6.7 days. Three patients had respiratory complications and two other patients required secondary surgery. All patients remained neurologically stable at the last follow-up with a mean follow-up period of 20.1 ± 12.8 months. Successful (Bridwell Grade I and II) fusion was achieved in 91.7% at the last follow-up
Conclusion : MIS PLECA for corpectomy appears to be a feasible, safe, and effective minimally invasive technique for select patients, particularly in those who cannot tolerate the traditional open approach. Additionally, a focal sagittal deformity correction can be achieved using minimally invasive vertebral column resection with reconstruction
