Dados do Trabalho

Título

Minimally Invasive Lateral Corpectomy of the Thoracolumbar Spine and reconstruction with expandable cage.

Objetivo

To evaluate the safety and performance of expandable cage in patients undergoing vertebral body corpectomy surgery of the thoracolumbar (TL) spine through a minimally invasive lateral retropleural or retroperitoneal approach.

Metodologia

This is a retrospective case series of 17 consecutive patients who underwent minimally invasive TL corpectomy and spinal reconstruction with expandable cage (X-Core 2). Electronic medical records were reviewed for demographic, operative, and clinical outcome data.

Resultados

Between december 2016 and february 2022, 17 consecutive cases of minimally invasive TL corpectomy were performed using using Xcore 2 (Nuvasive) expandable cage for vertebral body reconstruction, comprising 8 men (47,1%) and 9 women (52,9%) with a mean age of 59 (38-72) years. Two different approaches were carried out: single position surgery in 9 patients (52,9%) and dual position surgery in 8 (47,1%) . Mean BMI (kg/m2) were 29.1 (24-37). Included comorbities were tobacco use 2(11,7%) diabetes 4( 23,5%) hypertension 10 (58,8%), hyperlipidemia/hypercholesterolemia 6 (35.2%). Indications for surgery were infection (n=3,17,7%), tumor (n=4, 23,5%), trauma (n= 10, 58,8%). Mean operative time and estimated blood loss was 364,8 minutes and 729,4 ml, respectively. Were used as graft: Attrax (n=5, 25%), Rib (n=5, 25%), vertebral body (n=1, 5%), Attrax + rib (n=3, 15%), Attrax + vertebral body (n=1, 5%), Attrax + vertebral body + rib (n=1, 5%),Attrax + vertebral body + ICB(n=1, 5%), Rib + vertebral body (n=3, 15%). The instrumented levels were T9-Iliac (n=2, 11.8%), T10-Iliac (n=1, 5.8%), T10-L2 (n=1, 5.8%), T10-L3 ( n=2, 11.8%), T10-L4 (n=1, 5.8%), T11-L1 (n=3, 17.6%), T11-L3 (n=1, 5.8% ), L1-L3 (n=1, 5.8%), L3-L5 (n=2, 11.8%), L3-Iliac (n=1, 5.8%), L4-S1 (n= 1, 5.8%), and lateral plate (n=1, 5,8%). No perioperative adverse event were observed. Mean length of stay were 6,1 days (1-18). No patient died. There were a total of 5 complications during hospital stay, including urinary tract infection 2 (11.7), pneumothorax 1 (5.8%), atelectasy 1 (5.8%), posterior fixation failure due to osteoporosis 1 (5.8%). Five patients (29,4%) required reoperation: cage dislocation (n=1, 5,8%), infection (n=1, 5,8%), pneumothorax (n=1, 5,8%), PJK (n=1, 5,8%), posterior fixation failure (n=1, 5,8%). Mean follow-up time was 15,4 months (1-48).

Conclusões

Corpectomy and reconstruction of the TL using Xcore 2 expandable cage is feasible and safe using a minimally invasive lateral retropleural or retroperitoneal approach.