Partial Costotransversectomy and Corpectomy for Thoracic Spinal Metastatic Disease: Operative Technique and Nuances:...

We describe the operative approach and management for thoracic metastatic disease in a 78-yr-old man with worsening mechanical lower back and left-sided thoracic radicular pain. Imaging of the thoracic spine revealed an osteolytic T11 mass with destruction of the left T11 pedicle and transverse process. Biopsy confirmed spinal metastasis from the liver. Preoperative angiogram was completed for localization of the artery of Adamkewicz and microparticle embolization of the left T11 intercostal artery. Surgical resection was supplemented with electrophysiological monitoring and neuronavigation. The corpectomy was approached by resecting the medial aspect of the rib, transverse process, and pedicle, which were all invaded with tumor. The left T11 nerve root was isolated and sacrificed to allow for placement of the expandable corpectomy cage and also resulted in sustained relief of the patient's radicular pain. The patient recovered from surgery well, with postoperative improvement of his pain. This case highlights the complex technical nuances of this procedure, and the importance of a thorough preoperative evaluation, including angiography, as proper identification of the artery of Adamkewitz can prevent severe neurological deficit from a spinal cord stroke. The patient consented to the procedure.