• Eleftherios Archavlis, Eike Schwandt, Michael Kosterhon, Angelika Gutenberg, Peter Ulrich, Amr Nimer, Alf Giese, and Sven Rainer Kantelhardt.
• Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany. Electronic address: neurosurgery@t-online.de.
• World Neurosurg. 2016 Jul 1; 91: 424-33.

Background And ObjectiveThe main difficulties of transpedicular corpectomies are lack of space for vertebral body replacement in the neighborhood of critical structures, the necessity for sacrifice of nerve roots in the thoracic spine. and the extent of hemorrhage due to venous epidural bleeding. We present a modified technique of transpedicular corpectomy by using an endoscopic-assisted microsurgical technique performed through a single posterior approach. A 3-dimensional (3D) preoperative reconstruction could be helpful in the planning for this complex anatomic region.MethodsSurface and volume 3D reconstruction were performed by Amira or the Dextroscope. The clinical experience of this study includes 7 cases, 2 with an unstable burst fracture and 5 with metastatic destructive vertebral body disease, all with significant retropulsion and obstruction of the spinal canal. We performed a comparison with a conventional cohort of transpedicular thoracic corpectomies.ResultsQualitative parameters of the 3D virtual reality planning included degree of bone removal and distance from critical structures such as myelon and implant diameter. Parameters were met in each case, with demonstration of optimal positioning of the implant without neurological complications. In all patients, the endoscope was a significant help in identifying the origins of active bleeding, residual tumor, extent of bone removal, facilitating cage insertion in a minimally invasive way, and helping to avoid root sacrifice on both sides.ConclusionsMicrosurgical endoscopic-assisted transpedicular corpectomy may prove valuable in enhancing the safety of corpectomy in destructive vertebral body disease. The 3D virtual anatomic model greatly facilitated the preoperative planning.Copyright © 2016 Elsevier Inc. All rights reserved.

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