Anterior/Anterolateral Thoracic Access and Stabilization from Posterior Approach: Transpedicular, Costotransversectomy, Lateral Extracavitary Approaches: Standard Intralesional Resection

  • James G. MalcolmEmail author
  • Michael K. Moore
  • Daniel Refai


With the introduction of new techniques and hardware, surgical approaches to the anterior thoracic spine have evolved over the past decades to lower morbidity, improve fusion, and balance quality of life outcomes. With advances in adjuvant therapies, the surgical treatment of spinal metastases remains palliative where the goals are decompression, stabilization, diagnosis, and local tumor control. The primary indications for surgery are to decompress severe canal stenosis for radioresistant tumors and to address mechanical instability.

While the laminectomy provides access to posterior pathology, it does not provide sufficient access to anterior pathology without significant neurological morbidity. Extending the dissection from a laminectomy, the transpedicular (TP), costotransversectomy (CT), and lateral extracavitary (LECA) approaches each offer progressively larger extent of resection and access to the anterior ventral thoracic spinal column.

This chapter presents an account of how we perform the lateral extracavitary approach. We detail preoperative planning, angiography, positioning, neuromonitoring, dissection, fusion, and cage placement. At each step we discuss technical nuances and strategies to avoid or manage complications. Through the description of the exposure and resection, it should become apparent that the LECA approach is within a continuum of posterior approaches to the anterior spine, with laminectomy, transpedicular, and costotransversectomy serving as limited versions of the LECA. By learning this approach, the techniques needed to complete the LECA exposure will enable the surgeon to also perform the exposure and resections for TP and CT.


Corpectomy Spinal metastases Lateral extracavitary Costotransversectomy Transpedicular 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • James G. Malcolm
    • 1
    Email author
  • Michael K. Moore
    • 1
  • Daniel Refai
    • 2
  1. 1.Emory University, Department of NeurosurgeryAtlantaUSA
  2. 2.Emory University, Department of Neurosurgery and OrthopaedicsAtlantaUSA

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