2012 Volume 26 Issue 2 Pages 182-190
Objectives : To describe a retrospectively reviewed cohort of patients who had undergone corpectomy and reconstruction of the thoracolumbar spine for multilevel continuous lesions and to discuss problems related to this procedure.
Patients and methods : Seventeen patients underwent 2-level or 3-level corpectomy for malignant tumor (11 patients), infection (4 patients), or burst fracture (2 patients). Where possible, anterior approaches were selected.
Results : Operative approaches included sternum splitting for T1-T2 lesions, extrapleural approaches for T4-L1 lesions, retroperitoneal approaches for L2-L4 lesions and posterolateral approaches for T3 lesions. Two-level corpectomy was performed in 12 patients and 3-level corpectomy in 7 patients. Cages (7 cases) and bone cement (5 cases) were used as the graft for spinal metastatic lesions, and autogeneous fibula grafts (4 cases) and ceramic spacers (1 case) were used for infected spinal lesions. Autogenous iliac bone (1 case) and ceramic spacer (1 case) were used for burst fractures. The bony endoplates were preserved and kyphotic deformities were corrected before and/or during surgery. For internal fixation, vertebral plates were used in 9 cases, pedicle screw and rod fixation systems where used in 4 cases, and a Luque rod was used in one case. All patients showed neurological improvement after their operations.
Of the 17 patients, initial fixation was maintained in 14 and bone fusion was achieved in 10, although bone fusion was not estimated in 4 due to progression in malignantcy. Anterior support failure occurred in 4 patients during the follow-up period, due to graft subsidence. Artificial graft materials were used in all 4 of these failed operations, and in 2 of these cases, the lesions were in the upper thoracic spine.
Conclusions : To achieve rigid spinal fixation, graft materials must be applied between intact vertebral endplates. In the upper thoracic spine, it is essential that the vertebrae be rigidly fixed.
