47. Minimally invasive prone lateral retropleural corpectomy vs decubitus lateral transpleural corpectomy: a comparative analysis of clinical outcomes

Abstract

BACKGROUND CONTEXT

Decubitus lateral transpleural approach has been traditionally applied for tackling thoracic spinal pathologies at the anterior column. However, reposition for posterior instrumentation was often needed for complex pathologies. Recently, minimally invasive prone lateral single-position spinal surgery was introduced to allow simultaneous manipulation of the anterior and posterior columns, avoiding re-draping and improving lordotic alignment. Compared with transpleural approach, minimally invasive retropleural approach has gained popularity as it avoids pleural invasion, diaphragm takedown and one-lung ventilation, thereby reducing postoperative complications like pleural effusion and pneumonia.

PURPOSE

By combining these two minimally invasive techniques, this study aims to evaluate the feasibility of prone lateral retropleural corpectomy and compares its pulmonary complications and surgical outcomes with the conventional decubitus lateral transpleural corpectomy.

STUDY DESIGN/SETTING

Retrospective study.

PATIENT SAMPLE

From 2016 to 2023, we retrospectively reviewed patients who underwent lateral thoracic corpectomy and posterior instrumentation on the same day for various thoracic spinal pathologies. Those without a postoperative 1-year follow-up or received lateral corpectomy without posterior instrumentation were excluded.

OUTCOME MEASURES

Clinical outcomes, thoracic kyphosis correction, and postoperative pulmonary complications were recorded and analyzed.

METHODS

The patients were divided into prone lateral retropleural corpectomy (RP) group (N=27) and conventional decubitus lateral transpleural corpectomy (TP) group (N=54). The outcome measures were compared between the two groups.

RESULTS

There were no significant differences in terms of age, sex, body mass index, Charlson comorbidity index, or etiologies between the two groups. The surgical lengths were also comparable (RP: 5.4 ± 2.0 vs TP: 5.5 ± 2.1, p = 0.97), but the RP group has significantly shorter corpectomy level (1.1 ± 0.3 vs 1.5 ± 0.7, p < 0.001). The thoracic kyphosis correction was greater in the RP group than in the TP group (21.0° ± 16.5° vs 8.8° ± 11.4°, p = 0.002). Regarding postoperative pulmonary complications, the RP group revealed a lower incidence of CP angle blunting (44.4% vs 74.1%, p = 0.009) and pneumonia requiring antibiotics (0% vs 18.5%, p = 0.026). Additionally, thoracic drainage duration was significantly shorter in the RP group (4.1 ± 2.9 vs 6.4 ± 4.1 days, p = 0.015), as well as a reduced hospital stay (21.2 ± 16.5 vs 38.2 ± 24.5 days, p < 0.001).

CONCLUSIONS

Minimally invasive prone lateral retropleural corpectomy is a safe and feasible alternative for thoracic spinal pathologies, providing superior kyphosis correction, fewer pulmonary complications, and shorter hospital stays compared to decubitus lateral transpleural corpectomy.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.