They introduced a first tube to perform a costotransversectomy and corpectomy on the more affected side. They then placed a contralateral tube to perform contralateral transpedicular decompression. This technique allowed circumferential decompression by pursuing contralateral transpedicular Erlotinib HCl completion of the corpectomy [13]. The lateral extracavitary approach is one of the most widely validated approaches for corpectomy in the thoracic spine. Decompression and neurologic outcomes are excellent, and complications are typically minor and self-limited [39�C41]. Nevertheless, muscle-dissection-related morbidity is severe, and the substantial tissue dissection and blood loss place severe systemic stress on the patient. One series described an average of 3100mL of blood loss and 7.

74 hours per case, although these numbers may have been exaggerated by a small number of complicated cases [39]. In contrast, minimally invasive posterolateral corpectomy appears to provide adequate decompression and instrumentation, with less blood loss and operative time [3]. An important advantage of this approach as opposed to midline posterior approaches is preservation of the midline posterior tension band. It also allows the ability to create longer constructs by placing percutaneous screws above and below the level of corpectomy. Nevertheless, the learning curve and patient morbidities may limit general applicability. 5. Posterior The transpedicular approach has been extensively utilized in patients whose comorbidities limit transthoracic and lateral extracavitary approaches [47�C51].

Outcomes appear favorable when compared with other open techniques, and the technique has been described for a wide range of pathology [47, 50, 52�C54]. Surgery consists of midline incision two levels above and below the level of pathology, with dissection to the lateral edge of the transverse processes. The posterior elements are removed, along with the bilateral facets, demonstrating the thecal sac and pedicles. The pedicles are then taken down, exposing the vertebral body for corpectomy and adjacent level discectomy. Multiple techniques have been described for placement of an expandable cages in the transpedicular approach: including thecal sac mobilization, rib head osteotomy, rib head disarticulation, and trap-door rib head osteotomy, with thinning of the rib to allow greenstick fracture and displacement with subsequent displacement [47, 52, 53].

Deutsch et al. performed minimally invasive transpedicular corpectomy in 8 patients with metastatic tumors [14]. They focused on patients older than 68 years of age, who were deemed to be poor candidates for open surgery, with less than one year of life expectancy, but significant neurologic deficit. They Drug_discovery first performed a 3cm incision above the transverse process of the more affected side.