Rod-Suspended "Hammock" Expanded Polytetrafluoroethylene Reconstruction for Posterolateral Chest Wall Defects After Multilevel En Bloc Spondylectomy.

Abstract

Background and objectives: Multilevel en bloc spondylectomy (MES) for thoracic spinal tumors occasionally requires combined resection of ribs and parietal pleura, resulting in a large posterolateral chest wall defect adjacent to posterior instrumentation and a vertebral body cage. If unreconstructed, lung may herniate through the defect, and intrathoracic contents may migrate toward implants and neural elements. Our objective was to describe a simple, reproducible rod-suspended "hammock" reconstruction using expanded polytetrafluoroethylene (ePTFE) for extensive posterolateral chest wall defects after MES.

Methods: We report 3 cases undergoing thoracic MES (2022-2025) at a single institution. Reconstruction used one or two 2-mm ePTFE (Gore-Tex) sheets sutured to rib stumps and anchored to adjacent intercostal muscles with 2-0 Ethibond. When 2 sheets were required, they were overlapped and sutured together. The barrier was routed anterior to the cage, delivered contralaterally, and suspended from the contralateral posterior rod under controlled tension, with approximately 1 cm of overlap onto the residual vertebral body.

Results: Three cases are presented (aneurysmal bone cyst, chondroblastoma, and osteosarcoma), including a combined anterior-posterior approach and a case requiring diaphragmatic resection. The technique was feasible under two-lung ventilation with gentle lung retraction. Rod suspension provided a readily available rigid anchor within the posterior field, enabling controlled tensioning to form a stable sling that separated lung and pleura from the paraspinal corridor, confirmed on postoperative computed tomography.

Conclusion: Rod-suspended "hammock" ePTFE reconstruction is a simple, adaptable technique for extensive posterolateral chest wall defects after multi-level MES with rib and pleural resection. By maintaining durable separation between intrathoracic contents and the reconstructed spine, it may help prevent postoperative lung herniation.