Thoracoscopic vertebral body replacement with an expandable cage after ventral spinal canal decompression

OBJECTIVE: Minimally invasive thoracic anterior surgery using a thoracoscopic approach has evolved to include spinal biopsy, debridement, discectomy, decompressive corpectomy, interbody fusions, and internal fixations. Minimal access techniques can potentially decrease surgical access morbidity and also reduce the time required for recovery and healing. The thoracoscopic approach for decompression, stabilization, and anterior vertebral reconstruction of thoracolumbar fractures is described. METHODS: In this article and video, we discuss patient selection, surgical positioning, port placement, thoracic level localization, exposure and removal of fractured vertebral bodies, anterior vertebral column reconstruction using an expandable cage, instrumentation, and postoperative management. RESULTS: The potential advantages of using a minimally invasive thoracoscopic approach include direct trajectory to anterior spine pathology, minimal tissue and rib retraction, and decreased postoperative pain and length of hospital stay. The associated disadvantages include the steep learning curve for the surgeon, the need to operate with twodimensional visual information and long instruments, and the requirement that one have an experienced surgical assistant. CONCLUSION: Minimally invasive surgery using a thoracoscopic approach for vertebral body replacement with an expandable cage can be performed safely. Expandable cages facilitate the vertebral body reconstruction via minimal access surgery.