Single-stage posterolateral Corpectomy and circumferential stabilization without laminectomy in the upper thoracic spine: cadaveric study and report of three cases

Surgical approach to the upper thoracic spine diseases is challenging since anterior interventions to this region are quite complicated with the presence of major vascular elements or important visceral and soft-tissue structures. Operative technique was performed initially on eight cadavers and then on three consecutive patients. Costotransvesectomy was performed on the left side and pediculectomy were added on the contralateral side to achieve wide visual angle during corpectomy. A cage was implanted into the field of corpectomy from the left side and the stabilization procedure was completed with posterior instrumentation. Anterior low cervical approach is less invasive than posterior approach for T2 level and above.The area below T3 level includes the heart, aorta, common carotid or brachiocephalic artery and thoracic duct favoring the safety of posterior approach which provides a sufficient surgical window for corpectomy and circumferential stabilization at a single operation. The corpectomy procedure could be clearly performed under bilateral visualization of healthy bony margins with this technique. Although preserved laminae and spinous process lose the connection to the involved segment and hanged to adjacent levels only with posterior ligamentous complex, we propose that a chance of interlaminar fusion could further contribute to spinal stabilization rather than posterior instrumentation only.