A Cadaver Study: The Relationship of Vital Organs of the Thoracolumbar Junction During a far Lateral Approach Using a T-12 Corpectomy Model.

Study design: Human cadaver study.

Objectives: To provide a qualitative and quantitative evaluation by demonstrating measurements of the proximity of vital structures involved and assessed injuries during a T12-corpectomy and cage implantation via a far lateral approach.

Material and methods: Six fresh-frozen adult cadaveric specimens were dissected according to standardized protocol. A formal left-sided far lateral T12-corpectomy was carried out by trained experienced spine fellows. Upon completion of the procedure, a cage was placed between T11 and L1. We then turned the patient supine and performed a formal celiotomy and sternotomy to allow for an open anterior central inspection of all structures concerned. Vital structures as in vessels, diaphragm, pleural membranes, neural elements, important foramina of the diaphragm (Bochdalek, Morgagni) and the thoracic duct were identified. Any injuries to these structures were recorded and proximity to key relevant structures to this exposure were measured.

Results: We were able to quantify the actual diaphragm excursions and describe its origins to the spine. There was no actual diaphragm injury in any of the cadavers and there were no injuries to the neurovascular structures. We found expected parietal but no visceral pleural injuries.

Conclusion: Our cadaver study identified the feasibility of performing a T12-corpectomy through a far lateral approach with no violation of the actual diaphragm and expected limited injuries to the parietal pleura only.