Technical Feasibility and Safety of Transpedicular Thoracic Partial Corpectomy Using Biportal Endoscopic Technique: A Novel Approach for Separation Surgery in Spinal Metastatic Disease.
Case Report
Bony metastases frequently involve the spinal column, most commonly the thoracic spine. Surgical interventions in spinal metastatic disease are palliative and effective in providing diagnoses, reducing pain, and maintaining ambulatory function through neural element decompression and improving axial pain and posture through spinal column stabilization. Surgeons must weigh the benefits of surgery against fragility and limited life expectancy in patients with cancer. Minimally invasive techniques such as tubular and endoscopic approaches modulate preoperative risk profiles by disrupting less tissue, which may hasten time for postoperative recovery and time to radiation and systemic therapy for disease control. Advancements in surgical technique and technology have expanded endoscopic indications in spinal oncology. Indications have evolved from biopsy and hybrid open minimally invasive surgery approaches to fully endoscopic separation surgery and gross total resection of nonmetastatic tumors. In the case presented in Video 1, we used a biportal endoscopic technique to separate an unstable T12 retropulsed burst fracture from the ventral thoracic spinal cord. The biportal endoscopic technique allowed use of standard instruments for partial corpectomy such as osteotomes, rongeurs, and drills assisted by endoscopic visualization. Minimally invasive surgery percutaneous instrumentation was performed to stabilize the spinal column. Postoperative imaging showed improved spinal alignment and adequate spinal canal decompression, which allowed the patient to be discharged on postoperative day 4 without wound complications and undergo stereotactic body radiation therapy. The patient consented to this procedure, and identifiable individuals consented to publication of their image.
