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Optimizing the right vertebral body approach for anterior spinal column reconstruction: a biomechanical analysis.
The traditional approach to the anterior column of the spine involves a unilateral right-sided corpectomy, resulting in a single unstable rib cage/vertebral column unit. From a biomechanical standpoint, a stable rib cage/vertebral column unit is imperative, since the axial load applied to the anterior column is fundamentally supported by the anterior 1/3 of the rib cage. The ultimate tensile strength of the ribs is approximately 80% of the total tensile strength of the rib cage. Thus, the conventional approach may sacrifice stability of the rib cage with resulting postoperative pain and morbidity. The purpose of this study was to describe a novel technique and biomechanical analysis of a new technique that employs a combination of anterior and posterior approaches (bilateral anterior and posterior rib cage approach). The unilateral anterior approach is most commonly used and results in a stable rib cage/vertebral column unit. A bilateral anterior rib cage/vertebral column approach has not been reported, and therefore no comparisons are available. This biomechanical analysis focused on the right body/tail vertebra, reflecting the clinical experience of the senior author. An instrumented bicortical rod with unilateral rod angles of 30 degrees and 60 degrees was subjected to axial and torsional loading. A left rib cage/vertebral column was tested in three conditions: a right corpectomy in a unilateral anterior rib cage/vertebral column with intact ribs, a right corpectomy in a bilateral anterior rib cage/vertebral column with intact ribs, and a right corpectomy in a bilateral anterior rib cage/vertebral column with resected ribs. Average failure loads and torque were significantly greater for both right rib cage/vertebral column conditions than for the unilateral rib cage/vertebral column approach (p Share this Page

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