They were able to decompress 75% of the canal from a single side. Bilateral decompression was performed when necessary to decompress the entire anterior canal. They did not instrument as they did not feel that stability had been compromised, and http://www.selleckchem.com/products/Y-27632.html given the palliative nature of the procedures [14]. Chou and Lu described minimally invasive transpedicular corpectomy with expandable cage reconstruction [15]. They describe the procedure for 8 patients and compare it to a similar open cohort. They perform a midline incision two levels above and below the level of interest, preserving the fascia. Percutaneous screws are placed two levels above and below the level of corpectomy. A midline fascial opening is performed over the level of interest, and an expandable tubular retraction system is placed.

The posterior elements are removed, followed by removal of the pedicles and adjacent level diskectomy. They then perform bilateral transpedicular corpectomy. They perform a trap door rib head osteotomy, allowing expandable cage placement. They comment that removing the tubular retractor and placing a cerebellar helps to insert the cage, along with rotating the cage while inserting it between the vertebral bodies. They did not perform arthrodesis in these cases. Compared to their open cohort, they showed lower blood loss, similar operative time, and similar complication rates [15]. 6. Discussion The varying approach corridors to the thoracic spine offer different advantages and drawbacks (Figure 5).

The anterior (transthoracic and thoracoscopic) approaches allows the broadest decompression of the vertebral body with the ability to visualize the entire anterior thecal sac, but presents complications associated with entering the thorax, and risks related to working adjacent to the aorta and azygos vein [5, 23, 29, 55]. Working in a ventral-to-dorsal direction forces the surgeon to constantly estimate his distance to the thecal sac [3]. Learning thoracoscopy also demands specialized training from the surgeon [11]. The retropleural approach offers a similar view to thoracoscopy without entering the pleura, but even the existing minimally invasive descriptions require at least a 6�C8cm incision, substantial rib resection, and an extensive retropleural dissection [12, 33].

This dissection is technically demanding, results in an increased risk of pleural violation and chest tube placement, and may be mechanically more awkward than the transthoracic approaches [31]. Figure 5 Axial CT image in midthoracic spine demonstrating the trajectory used in the various minimally invasive approaches for corpectomy. The posterolateral approach allows surgeons to use a more familiar surgical angle (Figure 4). The minimally invasive variant spares Drug_discovery much of the muscle dissection classically associated with the lateral extracavitary approach, decreasing blood loss, and surgical time [3, 45].