Thoracic Corpectomy

Sometimes the source of thoracic cord compression, deformity or instability lies within a vertebral body itself — such as a tumour deposit, a collapsed or destroyed vertebra, or extensive disease compressing the cord from the front. In these cases, decompressing the cord and restoring the spine's support requires removing the affected vertebral body and reconstructing the column. Thoracic corpectomy addresses this directly, taking away the compressing and structurally compromised bone and replacing it with a supportive reconstruction.

In a thoracic corpectomy, the affected vertebral body — along with the discs above and below — is removed, decompressing the spinal cord from the front. The gap is reconstructed with a strut of bone graft or a cage that restores height and bears load, and the spine is stabilised with instrumentation. This can be achieved through different routes: from the back (a posterior or posterolateral approach), from the side or chest (an anterior or lateral approach), or a combination, chosen according to the level, the pathology and the individual. The reconstruction fuses over the following months, supported by the fixation.

Thoracic corpectomy can be considered where a vertebral body is causing cord compression or serious instability that cannot be adequately addressed otherwise — for example a spinal tumour, a severe deformity requiring reconstruction, or extensive disease compressing the cord from the front. Because it is a major undertaking, the decision weighs the severity of the problem, the person's overall health and goals, and the alternatives. The approach is planned carefully, and the operation is reserved for situations where this degree of decompression and reconstruction is genuinely required.

The evidence, much of it from the tumour setting where thoracic corpectomy is commonly needed, examines the different approaches and their outcomes. Pooled analyses comparing anterior, posterior and combined routes for thoracic corpectomy, and series reporting outcomes and complications, help match the approach to the individual and inform expectations. The literature reflects that this is major surgery with a meaningful complication profile, chosen when the benefits justify it. The balanced view is that thoracic corpectomy is an effective way to decompress the cord and reconstruct the spine for serious front-of-column problems, with the approach individualised.

This is major surgery, performed under general anaesthetic, usually with a hospital stay of several days or more and a recovery that depends on the underlying condition and the approach used. The main aims are to relieve pressure on the cord and restore a stable, supportive spine; where the cord was compressed, neurological improvement typically occurs gradually. Rehabilitation supports recovery. As with any major operation there are significant risks, which are discussed fully beforehand. Whether a thoracic corpectomy is the right choice for a given person is decided together.

• —Spiessberger A, et al. Thoracolumbar corpectomy/spondylectomy for spinal metastasis: a pooled analysis comparing seven surgical approaches. Eur Spine J 2020. (PMID 31641907)
• —Chiu RG, et al. Anterior versus posterior approach for thoracic corpectomy: an analysis of risk factors, outcomes and complications. World Neurosurg 2018. (PMID 29778596)
• —Lau D, et al. Outcomes of posterior thoracic corpectomies for metastatic spine tumours: an analysis of 90 patients. World Neurosurg 2018. (PMID 30500586)
• —Eleraky M, et al. Thoracolumbar vertebral reconstruction after surgery for metastatic spinal tumors: long-term outcomes. Neurosurg Focus 2005. (PMID 16190607)