Due to the complex anatomy and biomechanics of the region, surgery for tumors of the thoracolumbar spine may be particularly challenging. This chapter describes the anatomic considerations, surgical decision-making, planning, and operative techniques required for the treatment of neoplastic disease of the thoracolumbar spine. Additionally, we herein describe the case of a large recurrent extrapleural solitary fibroma in a 63-year-old female with normal neurologic function. The left-sided paraspinal tumor, from T9 to L2, was resected en bloc with wide margins—in order to offer the best prognosis and minimize local recurrence. This case illustrated that with careful preoperative planning and preparation, a staged anteroposterior procedure could be safely performed for en bloc resection of large primary tumors involving the thoracolumbar region.
Extrapleural solitary fibrous tumor En bloc Spine Rhoracolumbar Tumor
This is a preview of subscription content, log in to check access.
Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012;221:507–36.CrossRefGoogle Scholar
Baaj AA, Papadimitriou K, Amin AG, Kretzer RM, Wolinsky JP, Gokaslan ZL. Surgical anatomy of the diaphragm in the anterolateral approach to the spine: a cadaveric study. J Spinal Disord Tech. 2014;27:220–3.CrossRefGoogle Scholar
du Plessis M, Ramai D, Shah S, Holland JD, Tubbs RS, Loukas M. The clinical anatomy of the musculotendinous part of the diaphragm. Surg Radiol Anat. 2015;37(9):1013–20.CrossRefGoogle Scholar
Lumsden AB, Colborn GL, Sreeram S, Skandalakis LJ. The surgical anatomy and technique of the thoracoabdominal incision. Surg Clin North Am. 1993;73:633–44.CrossRefGoogle Scholar
Konig MA, Milz S, Bayley E, Boszczyk BM. The direct anterior approach to the thoracolumbar junction: an anatomical feasibility study. Eur Spine J. 2014;23:2265–71.CrossRefGoogle Scholar
Dakwar E, Ahmadian A, Uribe JS. The anatomical relationship of the diaphragm to the thoracolumbar junction during the minimally invasive lateral extracoelomic (retropleural/retroperitoneal) approach. J Neurosurg Spine. 2012;16:359–64.CrossRefGoogle Scholar
Fahim DK, Kim SD, Cho D, Lee S, Kim DH. Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation. J Neurosurg Spine. 2011;15:532–40.CrossRefGoogle Scholar
Walsh GL, Gokaslan ZL, McCutcheon IE, Mineo MT, Yasko AW, Swisher SG, et al. Anterior approaches to the thoracic spine in patients with cancer: indications and results. Ann Thorac Surg. 1997;64:1611–8.CrossRefGoogle Scholar