Thoracic Transpedicular Corpectomy

Indications

• The thoracic transpedicular approach provides access to the lateral spinal canal, the neural foramina, and a portion of the posterolateral vertebral body. A bilateral transpedicular approach can provide up to 270 degrees of decompression. Common pathologies treated by thoracic transpedicular corpectomy include lateral disk herniations, epidural tumor, osteomyelitis or diskitis with or without abscess, and lateral canal compression from trauma.

• Adjunct posterior segmental fixation can be performed for unstable lesions associated with trauma or for deformity. An anterior graft or cage should be placed unless a minimal amount of vertebral body is removed, as in a transpedicular biopsy.

• Many approaches are available for thoracic lesions, including thoracotomy, retropleural, extensive lateral extracavitary, and costotransversectomy approaches. The appropriate procedure depends on the following factors: (1) the location of the lesion (bone, epidural, paraspinal); (2) the angle of view needed; (3) the nature of the specific lesion (hard or soft, invasive or encapsulated); (4) the goal of treatment (en bloc resection or palliative decompression); (5) the patient’s comorbidities and their ability to tolerate a thoracotomy; and (6) the surgeon’s familiarity with technical aspects of the procedure. Transpedicular corpectomy is often used for patients with acute neurologic decline from epidural metastasis in whom palliative decompression rather than en bloc resection is the goal.