Middle column trough technique to dissect the tumor away from the vessels for safe resection of anterior lumbar chondrosarcoma with major vascular involvement-A Technical Report.

backgroundEn-bloc resection of anterior column spinal chondrosarcomas with major vascular involvement presents significant surgical challenges. When the inferior vena cava (IVC) and renal vessels are intimately adherent to tumor, nephrectomy may be considered to achieve adequate margins. Herein we present a case in which a proof-of-concept strategy was used to resect a chondrosarcoma with vascular and renal injury risks. CASE DESCRIPTION: We present a novel surgical technique for resection of an anterior compartment chondrosarcoma spanning L1-L3 with IVC and left renal vessel involvement. Following multidisciplinary discussion including consideration of nephrectomy, a staged bilateral thoracolumbar approach was performed. A middle column trough was created through L1-L3 vertebrae to facilitate posterior mobilization of the anterior column tumor away from the draped IVC and renal vessels, avoiding nephrectomy. TECHNIQUE: Through sequential bilateral thoracolumbar approaches via the 10th rib bed, a 1 cm anteroposterior width trough was created through the anterior-middle third of L1-L3 vertebral bodies. This allowed controlled posterior displacement of the anterior column tumor, indirectly decompressing the IVC and creating a safe dissection plane from the adherent great vessels including left renal vessels. Following en-bloc resection, reconstruction was performed using humeral shaft allograft with anterior instrumentation from T12 to L4, followed by posterior stabilization one week later.

conclusionThe middle column trough technique provides a safe surgical corridor for mobilization and resection of anterior column spinal tumors with major vascular involvement, facilitating vessel dissection that would otherwise require nephrectomy while achieving en-bloc resection with adequate oncological margins.