Pterion Prep CraniPro VUMC Case Prep
2026-06-27

Case Prep: Vertebral Corpectomy and Reconstruction (Metastatic / Primary Vertebral Tumor)

Case / Approach Snapshot

One-Liner

[Age]yo [M/F] with a [metastatic / primary] tumor of the [T_/L_] vertebral body with [cord compression / instability / intractable pain] planned for [posterolateral / anterior / combined] corpectomy, decompression, and instrumented reconstruction.

Figures, Imaging & Video

🎥 Operative video — search operative video on YouTube ▸ · The Neurosurgical Atlas ▸

CNS Video Library

🧭 Operative approach: Transthoracic approach — detailed corridor setup, step-by-step technique & figures

Neurosurgical Atlas · AO Spine / Surgery Reference · Radiopaedia · PubMed Central — operative figures © linked; see media-sources.md

High-Yield Literature

Curated Image Set

Open-access figures are embedded from PubMed Central articles and kept unique to this guide.

Vertebral Corpectomy Reconstruction — Fig. 1 Fig. 1. Sagittal (a) and Axial (b) T1 Post Gadolinium MRI: Expansile lytic lesion involving the T10 vertebral body and posterior elements with pathologic fracture and epidural compression. Source: Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases — North American Spine Society Journal 2021; CC BY-NC-ND.

Vertebral Corpectomy Reconstruction — Fig. 2 Fig. 2. Axial T1 MRI Thoracic Spine Post-Gadolinium: superior endplate of the caudal T11 vertebral body indicating larger footprint of reconstruction required during VBR. Source: Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases — North American Spine Society Journal 2021; CC BY-NC-ND.

Vertebral Corpectomy Reconstruction — Fig. 3 Fig. 3. Intra-operative view of the posterior approach for vertebral body reconstruction. Source: Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases — North American Spine Society Journal 2021; CC BY-NC-ND.

Vertebral Corpectomy Reconstruction — Fig. 4 Fig. 4. AP (a) and lateral (b) radiographs of the thoracic spine showing bilateral expandable cage placement during vertebral body reconstruction. Source: Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases — North American Spine Society Journal 2021; CC BY-NC-ND.

Vertebral Corpectomy Reconstruction — Fig. 5 Fig. 5. Coronal (a) and axial (b) CT Thoracic Spine Without IV Contrast at 6-month follow up showing arthrodesis across the corpectomy defect Source: Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases — North American Spine Society Journal 2021; CC BY-NC-ND.

Vertebral Corpectomy Reconstruction — Fig. 6 Fig. 6. Representative mid-sagittal (a) and axial (b) CT cuts of L1 burst fracture with significant bony retropulsion. Source: Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases — North American Spine Society Journal 2021; CC BY-NC-ND.

Vertebral Corpectomy Reconstruction — Fig. 7 Fig. 7. Representative mid-sagittal STIR MRI (a) and T2 sequence MRI (b) of L1 burst fracture demonstrating cord compression. Source: Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases — North American Spine Society Journal 2021; CC BY-NC-ND.

Vertebral Corpectomy Reconstruction — Fig. 8 Fig. 8. Final intraoperative AP (a) and lateral (b) radiographs for L1 vertebral body reconstruction with bilateral expandable cages. Source: Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases — North American Spine Society Journal 2021; CC BY-NC-ND.

Vertebral Corpectomy Reconstruction — Figure 4 Figure 4. A 53-year-old male who underwent 1-level corpectomy with a titanium mesh cage used for cervical reconstruction.The preoperative cervical X-ray film (4A) and immediately postoperative… Source: Evaluation of Anterior Cervical Reconstruction with Titanium Mesh Cages versus Nano-Hydroxyapatite/Polyamide66 Cages after 1- or 2-Level Corpectomy for Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 117 Patients — PLoS ONE 2014; CC BY.

Vertebral Corpectomy Reconstruction — Figure 5 Figure 5. A 46-year-old male who underwent 2-level corpectomy with a titanium mesh cage used for cervical reconstruction.A cervical MRI scan (5A) shows multi-level disc herniations (C4/5, C5/6,… Source: Evaluation of Anterior Cervical Reconstruction with Titanium Mesh Cages versus Nano-Hydroxyapatite/Polyamide66 Cages after 1- or 2-Level Corpectomy for Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 117 Patients — PLoS ONE 2014; CC BY.

History of Present Illness

Imaging Review

MRI whole spine (T1±Gad, T2, STIR)

Labs

Neurological Examination

Surgical Planning

Case Logistics, OR Needs & Orders

Goals & Approach

Position

Key Surgical Steps (Posterolateral Transpedicular Corpectomy)

  1. Level localization, midline incision, expose posterior elements
  2. Pedicle screw instrumentation above and below (typically 2 levels each side) for reconstruction
  3. Laminectomy at involved level, identify and protect cord/thecal sac
  4. Transpedicular/costotransversectomy access: remove pedicle(s), facets, rib head (thoracic) to reach the vertebral body laterally/anteriorly
  5. Ligate the involved nerve root (thoracic — sacrificable) for working corridor if needed
  6. Corpectomy: piecemeal removal of tumor/vertebral body, circumferential decompression of the thecal sac (remove posterior body/epidural tumor)
  7. Anterior column reconstruction: expandable cage / PMMA + mesh in the corpectomy defect
  8. Place rods, secure construct, restore alignment, compress/distract as needed
  9. Confirm decompression and hardware on fluoroscopy
  10. Hemostasis (tumor bleeding — embolization helps), drain, closure

Critical Anatomy & Structures at Risk

  1. Spinal cord — compression, manipulation; MAP support
  2. Segmental/radicular arteries (artery of Adamkiewicz, thoracolumbar left) — cord infarction
  3. Great vessels (anterior, esp. lumbar/anterior approach), pleura/lung (thoracic), aorta
  4. Nerve roots (thoracic sacrificable; lumbar must preserve)
  5. Dura (epidural tumor adherence — CSF leak)

Equipment

Monitoring

Anesthesia

Potential Complications

  1. Major hemorrhage (vascular tumors — embolize preop)
  2. Neurological injury (cord/root/vascular)
  3. Hardware failure/pseudarthrosis (osteoporotic/irradiated bone, limited life expectancy), adjacent fracture
  4. CSF leak, wound complications (irradiated/immunocompromised field), infection
  5. Approach-specific (pleural, vascular, bowel)

Operative Note Template

Preoperative Diagnosis: [Metastatic/primary] tumor of [T_/L_] with epidural cord compression [ESCC __] and instability [SINS __]

Postoperative Diagnosis: Same

Procedure: [T_/L_] [posterolateral transpedicular] corpectomy with circumferential decompression and instrumented reconstruction (pedicle screws + expandable cage)

Surgeon / Assistant: Anesthesia: General endotracheal EBL / Fluids / Blood products: [crossmatched 2–4 units; cell saver] Adjuncts: Fluoroscopy/navigation, high-speed drill; SSEP/MEP/EMG; MAP > 85; preoperative embolization Implants: Pedicle screws/rods, expandable cage/PMMA, bone graft Complications: None

Indications: [Age]yo [M/F] with [a metastatic/primary] tumor at [T_/L_] causing epidural cord compression [and instability]. [Preoperative embolization was performed for the vascular tumor.] Separation surgery/decompression with stabilization was planned (adjuvant radiation to follow for mets). Risks (hemorrhage, neurological injury, hardware failure) discussed.

Description of Procedure: After consent and time-out, general anesthesia was induced (MAP > 85, crossmatched blood/cell saver) and neuromonitoring established. The patient was positioned prone and the levels confirmed. Pedicle screws were placed above and below for reconstruction. A laminectomy was performed and the cord/thecal sac protected.

Via a transpedicular/costotransversectomy corridor [with ligation of the involved thoracic nerve root], the pedicle(s) were removed and a corpectomy performed, achieving circumferential decompression by removing the posterior vertebral body and epidural tumor. An expandable cage [/PMMA-mesh] reconstructed the anterior column, rods were secured, and alignment confirmed on fluoroscopy. Hemostasis was obtained (embolization-assisted). Neuromonitoring remained stable.

A drain was placed and closure performed in layers. The patient was transferred to the ICU with MAP support and serial neuro/hemoglobin monitoring.

Postoperative Plan

Chief-Level Case Review

Use these as the senior-level mental model for Vertebral Corpectomy and Reconstruction (Metastatic / Primary Vertebral Tumor):

Common Pimp Questions

Use these to pressure-test preparation for Vertebral Corpectomy and Reconstruction (Metastatic / Primary Vertebral Tumor):

  1. What neurologic level and root are responsible for the presenting deficit?
  2. What is the decompression target and how will you know it is adequately decompressed?
  3. What instability, deformity, bone-quality, or fusion variable changes the construct?
  4. What vascular, visceral, dural, or neural structure is the main structure at risk?
  5. What postop brace, drain, mobilization, MAP, antibiotic, and DVT plan should be ordered?

Attending Preference Variables

Items that commonly vary by surgeon or institution: