Minimally Invasive Lateral Access Corpectomy for a Solitary Renal Cell Carcinoma Spinal Metastasis: A Case Report

Abstract

Spinal metastases can present with neurological symptoms due to cord compression which often requires urgent surgical decompression and fixation. However, the posterior spinal approach has limitations in cord decompression. We describe our institution’s experience of a Thoracic 12 corpectomy done via a minimally invasive retropleural approach for a patient with a metastatic spinal tumour. A 63 year old presented with a 1 month history of worsening atraumatic back pain with lower limb radicular pain and weakness. Magnetic Resonance Imaging (MRI) showed a T12 pathological fracture with vertebral body retropulsion causing cord compression. A Computed Tomography (CT) abdomen scan showed a heterogenous enhancing mass in the superior pole of the right kidney, suspicious of a renal cell carcinoma. He underwent initial posterior pedicle screw instrumentation from T10-L2 and a T12 bilateral laminectomy with right T12 pedicle bone biopsy, followed by a minimally invasive lateral access T12 corpectomy. His weakness improved and he had subsequent radiation therapy, chemotherapy and a right nephrectomy with good recovery. Minimally invasive lateral access retropleural approach can be considered in metastatic spinal tumour cases with cord compression as it allows for circumferential decompression while avoiding risks of anterior spinal surgery.

Keywords

• corpectomy
• lateral access
• metastatic spinal tumour