- Indication
- Vertebral body destruction secondary to TB.
- Trauma: Choi 2017
- Tumour
Procedure:
- Intraoperative neuromonitoring recommended.
- Prone Positioning:
- Place patient prone on radiolucent operating table.
- Posterior Exposure
- Perform midline posterior incision; expose vertebrae above and below the target level.
- Pedicle Screw Fixation
- Insert pedicle screws above and below the affected segment.
- can place a short screw into a partially affected vertebrae
- Place rod in contralateral side
- Laminectomy
- Perform laminectomy at target level to expose the dura.
- Facet & Pedicle Removal
- Total resection of the superior and inferior articular processes above and below the affected vertebral body’s.
- After the pedicle is an island, core out the pedicle with a US bone saw, pituitary rongeur, currate,
- After the pedicle is cored out, remove the wall of the pedicle.
- Identify nerve root and disc space
- Disc Space Exposure
- Corpectomy
- Remove the vertebral body (corpectomy) and perform microdiscectomies above and below using drill, curettes, and rongeurs.
- Enter vertebral body and remove the cancellous bone,
- Then remove any vertebral body wall
- Discectomy
- with knife, currate
- Endplate Preparation
- Prepare superior and inferior endplates for cage insertion.
- Make sure that the bone contract surface of the cage flat and without osteophytes.
- This can be smoothen with an ultrasonic bone saw or a burr
- Check if nerve root need sacrificing
- T2-T12 are sacrifice-able
- L1
- in older female are sacrifice-able.
- Do not sacrifice the wonder in a male or a young female.
- No motor side effects but has genitofemoral side-effects
- Insertion of bone graft
- Only do this step if there is purposefully left behind remanent vertebral body
- Bone graft placed in the disc space just around the annulus so that there is a continous bone between the vertebral bodies in the cranial caudal plane
- Expandable Cage Placement
- Insert compressed expandable titanium cage through the space between nerve roots.
- The cage needs to be a tight fit and the expanded locked in placed.
- Rod Placement in ipsilateral side
- Attach rods to pedicle screws on both sides.
- Final Fixation
- Secure rods; add transverse connectors if needed.
- Closure
- Close wound in layers.
Note:
- Posterior-only approach avoids anterior approach morbidity.
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