Table 2 A brief review of approaches for thoracic corpectomy
Corridor | Trajectory | Accessible spinal levels | Access Surgeon Required? | Positioning | Advantages | Limitations | Variations |
|---|---|---|---|---|---|---|---|
Transsternal | Anterior/Anterolateral | T1-T4 | Variable | Supine | Direct visualization of major vessels. Ventral pathology readily addressed with straightforward anterior column release for deformity. | Mobilization of major vessels, esophagus. Dorsal pathology inaccessible. Second stage posterior stabilization required. | Not applicable |
Transthoracic | Anterior/Anterolateral | T3-T10 *T10-L1 with transdiaphragmatic | Yes | Lateral decubitus | Direct visualization of major vessels. Ventral pathology readily addressed with straightforward anterior column release for deformity. | Mobilization of major vessels, esophagus. Morbidity of thoracotomy (need for lung deflation, post-operative chest tube, etc.). Dorsal pathology inaccessible. Second stage posterior stabilization required. | 1. Video-assisted thorascopy 2. Transdiaphragmatic MIS and mini-open variants for each. |
Retroperitoneal | Anterolateral | T12-L2 | Variable | Lateral decubitus | Straightforward corpectomy and anterior column release for deformity. Bilateral decompression possible. Avoids the spinal canal. Large cage/graft. | Risk to the lumbosacral plexus. Inadvertent peritoneal entry and injury to its vessels and viscera. Dorsal pathology inaccessible. | Can be combined with retropleural approach for expanded access to the lower thoracic vertebra. Single position (e.g., prone lateral) surgery for concurrent posterior instrumentation. |
Extracavitary | Lateral/Posterolateral | T1-T12 *Parascapular limited to T1-T4 | No | Prone | Circumferential access to the spinal canal. Familiar approach. Posterior tension band remains intact. Straightforward posterior instrumentation. | Requires extensive soft tissue dissection and rib resection. Challenging working angles with limited vertebral body resection. Risk of pleural/lung injury. Morbidity of costectomy/costotomy. | 1. Retropleural 2. Parascapular 3. Lateral MIS and mini-open variants for each. Costoplasty possible. |
Transcostal | Posterolateral | T1-T12 | No | Prone | Circumferential decompression possible when bilateral. Familiar approach. Straightforward posterior instrumentation. | Morbidity of costectomy/costotomy. Disruption of the posterior tension band. Higher risk of durotomy and neurological injury. | 1. Costotransversectomy 2. Transcostovertebral MIS and mini-open variants for each. Costoplasty possible. |
Transpedicular | Posterior | T1-T12 | No | Prone | Circumferential decompression possible when bilateral. Familiar approach. Straightforward posterior instrumentation. | Morbidity of costectomy/costotomy. Disruption of the posterior tension band. Higher risk of durotomy and neurological injury. | MIS and mini-open variants for each. Costoplasty possible. |